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LIVING WELL CENTRAL PHARMACY
CH042110 GEORGIA MOUNTAINS HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
GEORGIA MOUNTAINS HEALTH SERVICES, INC.
Subdivision Name
MORGANTON
Type
HRSA-Funded Health Center
340B ID
CH042110
Entity Address
165 Blue Ridge Overlook
Blue Ridge, GA 30513-4431
Grant Number
H80CS00093
Participating Start Date
10/1/2006
Last Recertification Date
2/3/2015
Entity Termination Date
10/1/2015
Pharmacy Details
Pharmacy Name
LIVING WELL CENTRAL PHARMACY
Pharmacy Address
2976 HIGHWAY 76 UNIT A
CHATSWORTH, GA 30705-6982
Pharmacy Comments
Contract Details
Approval Date
8/9/2011
Contract Begin Date
8/9/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2015
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
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