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GEORGIA CVS PHARMACY, L.L.C.
CAH111314-00 LIFEBRITE COMMUNITY HOSPITAL OF EARL
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Covered Entity Details
Entity Name
LIFEBRITE COMMUNITY HOSPITAL OF EARL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH111314-00
Entity Address
11740 COLUMBIA STREET
BLAKELY, GA 39823
Medicare Provider Number
111314
Participating Start Date
10/1/2023
Last Recertification Date
9/4/2024
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
10/8/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Morgan Dunn, CEO
(601) 382-6315
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/8/2024
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