Contract Pharmacy Details

WAL-MART PHARMACY #10-5812
CH042110 GEORGIA MOUNTAINS HEALTH SERVICES, INC.

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 #10-5812

Pharmacy Address

97 COMMERCE DRIVE
BLUE RIDGE, GA 30513

Pharmacy Comments

Contract Details

Approval Date

7/3/2014

Contract Begin Date

10/1/2014

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

7/3/2014

340B Drug Pricing Program Database