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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
WALGREENS #19828
305 W MAIN ST
MANCHESTER, GA 31816
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
Walgreens
Lisa Villarreal, Analyst, 340B Operations
(847) 964-6183
Signed By Date
1/11/2024
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