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WAL-MART PHARMACY 10-0843
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
WAL-MART PHARMACY 10-0843
Pharmacy Address
165 US HWY 19 N
CAMILLA, GA 31730-1412
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
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
4/12/2024
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