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AVITA PHARMACY 1046
HV00100 Ware County Board of Health
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Covered Entity Details
Entity Name
Ware County Board of Health
Subdivision Name
Toombs Wellness Center
Type
Ryan White Part C
340B ID
HV00100
Entity Address
714 NW Broad St.
Lyons, GA 30436
Grant Number
H76HA00100
Participating Start Date
1/1/2016
Last Recertification Date
2/10/2025
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
7/7/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rosemarie Parks, District Health Director
(912) 285-6002
Contract Pharmacy Representative
Avita Pharmacy
Chris Creamer, Chief Pharmacy Officer
(404) 856-7080
Signed By Date
7/7/2023
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