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WALMART PHARMACY #10-3635
CH04479C PRIMARY HEALTH CARE CENTER OF DADE, INC.
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Covered Entity Details
Entity Name
PRIMARY HEALTH CARE CENTER OF DADE, INC.
Subdivision Name
Primary Health Care Center Cedartown
Type
HRSA-Funded Health Center
340B ID
CH04479C
Entity Address
118 E GIRARD AVE
CEDARTOWN, GA 30125-2778
Grant Number
H80CS00649
Participating Start Date
10/1/2014
Last Recertification Date
2/9/2024
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY #10-3635
Pharmacy Address
1155 BATTLEFIELD PKWY
FORT OGLETHORPE, GA 30742
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
DIANA U. ALLEN, CEO
(706) 620-4494 Ext: 8549
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/16/2024
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