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GEORGIA CVS PHARMACY, L.L.C.
CH04479P 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 Healthcare Center at Rossville Middle School - SBHC
Type
HRSA-Funded Health Center
340B ID
CH04479P
Entity Address
316 Bull Dog Trl
Rossville, GA 30741-6336
Grant Number
H80CS00649
Participating Start Date
1/1/2023
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
GEORGIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07223
807 N. MAIN ST.
LAFAYETTE, GA 30728
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
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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