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COLISEUM PARK PROFESSIONAL
CH045180 COMMUNITY HEALTH CARE SYSTEMS INC
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CARE SYSTEMS INC
Subdivision Name
COMMUNITY HEALTH CARE SYSTEMS, INC.
Type
HRSA-Funded Health Center
340B ID
CH045180
Entity Address
2251 W Elm St
Wrightsville, GA 31096-2017
Grant Number
H80CS00507
Participating Start Date
11/28/2005
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
COLISEUM PARK PROFESSIONAL
Pharmacy Address
380 HOSPITAL DR STE 175A
MACON, GA 31217
Pharmacy Comments
Contract Details
Approval Date
4/17/2023
Contract Begin Date
6/6/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carla Belcher, CEO
(478) 552-7384 Ext: 1211
Contract Pharmacy Representative
Powells Pharmacy
Bob Moody, Owner
(478) 745-5431
Signed By Date
4/17/2023
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