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WAL-MART PHARMACY 10-4409
CH044790 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 TRENTON
Type
HRSA-Funded Health Center
340B ID
CH044790
Entity Address
13570 N Main St
Trenton, GA 30752-2012
Grant Number
H80CS00649
Participating Start Date
1/1/1998
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4409
Pharmacy Address
1801 NATHAN DEAN BYPASS
ROCKMART, GA 30153
Pharmacy Comments
Contract Details
Approval Date
4/12/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DIANA U. ALLEN, CEO
(706) 620-4494 Ext: 8549
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/12/2024
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