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AVITA PHARMACY 1046
CH040490 CURTIS V. COOPER PRIMARY HEALTH CARE, INC.
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Covered Entity Details
Entity Name
CURTIS V. COOPER PRIMARY HEALTH CARE, INC.
Subdivision Name
FORMERLY WESTSIDE URBAN HLTH CTRS, INC.
Type
HRSA-Funded Health Center
340B ID
CH040490
Entity Address
106 EAST BROAD STREET
SAVANNAH, GA 31401
Grant Number
H80CS00082
Participating Start Date
12/1/1992
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1046
Pharmacy Address
LONG'S DRUGS OF SANDERSVILLE, GEORGIA, I
2140 PEACHTREE RD NW STE 232
ATLANTA, GA 30309
Pharmacy Comments
Contract Details
Approval Date
5/3/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Albert B. Grandy JR., CEO
(912) 527-1117
Contract Pharmacy Representative
PMQ Group, LLC dba Avita
Chris Creamer, SVP
(469) 592-2000
Signed By Date
5/3/2023
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