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GEORGIA CVS PHARMACY, L.L.C.
RRC110074-00 PIEDMONT ATHENS REGIONAL MEDICAL CE
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Covered Entity Details
Entity Name
PIEDMONT ATHENS REGIONAL MEDICAL CE
Subdivision Name
Type
Rural Referral Center
340B ID
RRC110074-00
Entity Address
1199 PRINCE AVENUE
ATHENS, GA 30306
Medicare Provider Number
110074
Participating Start Date
12/4/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
GEORGIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05658
2041 N. ELM ST.,
COMMERCE, GA 30529
Pharmacy Comments
Contract Details
Approval Date
10/21/2024
Contract Begin Date
12/9/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Justin Roberts, CFO
(706) 475-3463
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2024
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