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COLISEUM PARK PROFESSIONAL
CH045211G FIRST CHOICE PRIMARY CARE, INC.
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Covered Entity Details
Entity Name
FIRST CHOICE PRIMARY CARE, INC.
Subdivision Name
First Choice Primary Care Poplar St
Type
HRSA-Funded Health Center
340B ID
CH045211G
Entity Address
400 Poplar Street
Macon, GA 31201-3336
Grant Number
H80CS08242
Participating Start Date
7/1/2021
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
COLISEUM PARK PROFESSIONAL
Pharmacy Address
380 HOSPITAL DR STE 175A
MACON, GA 31217
Pharmacy Comments
Contract Details
Approval Date
1/11/2023
Contract Begin Date
1/27/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Katherine McLeod, CEO
(478) 254-7204
Contract Pharmacy Representative
Powells Pharmacy
Bob Moody, Owner
(478) 745-5431
Signed By Date
1/11/2023
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