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GEORGIA CVS PHARMACY, L.L.C.
CH044369A PRIMARY CARE OF SOUTHWEST GEORGIA, INC.
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Covered Entity Details
Entity Name
PRIMARY CARE OF SOUTHWEST GEORGIA, INC.
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH044369A
Entity Address
360 COLLEGE STREET
BLAKELY, GA 39823
Grant Number
H80CS06454
Participating Start Date
12/6/2005
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
GEORGIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05618
11685 COLUMBIA ST.,
BLAKELY, GA 39823
Pharmacy Comments
Contract Details
Approval Date
4/7/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ANN ADDISON, CEO
(229) 723-2660
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/7/2017
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