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CHAMPIONS PHARMACY
STD30236 Empowerment Resource Center
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Covered Entity Details
Entity Name
Empowerment Resource Center
Subdivision Name
Serve Clayton Initiative
Type
Sexually Transmitted Diseases
340B ID
STD30236
Entity Address
1117 Battlecreek Road
Jonesboro, GA 30236
Grant Number
5NH25PS004329-04-00
Participating Start Date
7/1/2020
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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