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GEORGIA CVS PHARMACY, L.L.C.
CH04479G 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
School Based Dental Mobile Unit
Type
HRSA-Funded Health Center
340B ID
CH04479G
Entity Address
87 S BURNT MILL RD
LA FAYETTE, GA 30728-4263
Grant Number
H80CS00649
Participating Start Date
4/1/2016
Last Recertification Date
2/9/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
GEORGIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03760
887 BATTLEFIELD PARKWAY
FT 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
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
DIANA U. ALLEN, CEO
(706) 620-4494 Ext: 8549
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/16/2024
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