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WAL-MART PHARMACY 10-1070
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
WAL-MART PHARMACY 10-1070
Pharmacy Address
88 HIGHLAND CROSSING
EAST ELLIJAY, GA 30540
Pharmacy Comments
Contract Details
Approval Date
4/13/2012
Contract Begin Date
4/13/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2015
Contacts
Covered Entity Signing Official
Randy Westbrook, CFO
(706) 946-5609
Contract Pharmacy Representative
Wal--Mart
Marcus Osborne, Sales & Contracting
(479) 204-8452
Signed By Date
4/6/2012
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