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HOLIDAY CVS, L.L.C.
FQHCLA384 Southwest Georgia Healthcare Clinics, Inc.
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Covered Entity Details
Entity Name
Southwest Georgia Healthcare Clinics, Inc.
Subdivision Name
Southwest Georgia Pediatric CLinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA384
Entity Address
205 Bresee Street
Donalsonville, GA 39845-1134
Grant Number
LALCS32518
Participating Start Date
7/1/2019
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
HOLIDAY CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03245
4684 HIGHWAY 90
MARIANNA, FL 32446
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
Donna L Williams, CEO
(229) 220-1077
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/12/2024
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