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GEORGIA CVS PHARMACY, L.L.C.
CH04743F GEORGIA HIGHLANDS MEDICAL SERVICE INC
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Covered Entity Details
Entity Name
GEORGIA HIGHLANDS MEDICAL SERVICE INC
Subdivision Name
GHMS Canton Center
Type
HRSA-Funded Health Center
340B ID
CH04743F
Entity Address
210 Oakside Ln
Canton, GA 30114-6417
Grant Number
H80CS00470
Participating Start Date
1/1/2021
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
GEORGIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07273
129 MARIETTA HIGHWAY
CANTON, GA 30114
Pharmacy Comments
Contract Details
Approval Date
4/9/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Todd Shifflet, CEO
(770) 887-1668 Ext: 1102
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/9/2024
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