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WAL-MART PHARMACY 10-0669
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 10-0669
Pharmacy Address
2545 E WALNUT AVE
DALTON, GA 30721
Pharmacy Comments
Contract Details
Approval Date
4/2/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2015
Contacts
Covered Entity Signing Official
Steven Miracle, CEO
(706) 946-5610
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/2/2014
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