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WAL-MART PHARMACY 10-2890
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
WAL-MART PHARMACY 10-2890
Pharmacy Address
5955 ZEBULON RD
MACON, GA 31210
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Katherine McLeod, CEO
(478) 254-7204
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
1/17/2023
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