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CHAMPIONS PHARMACY
FP30303 Empowerment Resource Center
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Covered Entity Details
Entity Name
Empowerment Resource Center
Subdivision Name
Comprehensive Intervention Clinic
Type
Family Planning (Title X only)
340B ID
FP30303
Entity Address
230 Peachtree St NW
SUITE 1800
ATLANTA, GA 30303-1514
Grant Number
FPHPA046164
Participating Start Date
4/1/2016
Last Recertification Date
5/8/2024
Pharmacy Details
Pharmacy Name
CHAMPIONS PHARMACY
Pharmacy Address
3886 PRINCETON LAKES WAY SW STE 180
ATLANTA, GA 30331-5511
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jacqueline Brown, Chief Executive Officer
(404) 526-1145
Contract Pharmacy Representative
Rx Meds
Xavier Bryant, CEO
(678) 705-5968
Signed By Date
7/17/2023
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