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GEORGIA CVS PHARMACY, L.L.C.
CH04813E VALLEY HEALTHCARE SYSTEM, INC.
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Covered Entity Details
Entity Name
VALLEY HEALTHCARE SYSTEM, INC.
Subdivision Name
VHcS Fortson Medical/Dental Center
Type
HRSA-Funded Health Center
340B ID
CH04813E
Entity Address
94 Mccrary Rd
Fortson, GA 31808-4558
Grant Number
H80CS00678
Participating Start Date
10/1/2009
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
GEORGIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04677
3617 HILTON AVE.
COLUMBUS, GA 31904
Pharmacy Comments
Contract Details
Approval Date
1/11/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Asante Hilts, CEO
(706) 987-8343
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/11/2024
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