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POLARIS SPECIALTY RX
CH046900 MEDCURA HEALTH, INC.
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Covered Entity Details
Entity Name
MEDCURA HEALTH, INC.
Subdivision Name
STONE MOUNTAIN
Type
HRSA-Funded Health Center
340B ID
CH046900
Entity Address
5582 MEMORIAL DRIVE
STONE MOUNTAIN, GA 30083
Grant Number
H80CS00179
Participating Start Date
4/1/2004
Last Recertification Date
2/16/2025
Pharmacy Details
Pharmacy Name
POLARIS SPECIALTY RX
Pharmacy Address
410 CLOVERLEAF DR
BALDWIN PARK, CA 91706
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeff Taylor, Chief Executive Officer
(404) 298-3250
Contract Pharmacy Representative
Poaris Specialty Pharmacy
David Rombro, CEO
(954) 919-1818
Signed By Date
7/15/2024
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