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GEORGIA CVS PHARMACY, L.L.C.
CH044369G Primary Care Of Southwest Georgia, Inc.
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Covered Entity Details
Entity Name
Primary Care Of Southwest Georgia, Inc.
Subdivision Name
Primary Care of Southwest Georgia - Early County Elementary School
Type
HRSA-Funded Health Center
340B ID
CH044369G
Entity Address
283 Martin Luther King Jr Blvd
Blakely, GA 39823-3455
Grant Number
H80CS06454
Participating Start Date
7/1/2022
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
GEORGIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05618
11685 COLUMBIA ST.,
BLAKELY, GA 39823
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
EDWIN JAMES, CFO
(229) 723-2660 Ext: 2131
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/9/2024
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