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EDEN PHARMACY LLC
CH040400 Southside Medical Center, Inc.
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Covered Entity Details
Entity Name
Southside Medical Center, Inc.
Subdivision Name
SOUTHSIDE MEDICAL CENTER - Main Center / Corporate HQ
Type
HRSA-Funded Health Center
340B ID
CH040400
Entity Address
1046 Ridge Ave SW
Atlanta, GA 30315-1640
Grant Number
H80CS00576
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
EDEN PHARMACY LLC
Pharmacy Address
1634 JONESBORO RD. SE
ATLANTA, GA 30315
Pharmacy Comments
Contract Details
Approval Date
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Claudio Azzariti, CFO
(404) 564-7009
Contract Pharmacy Representative
Eden Pharmacy LLC
Akshaykumar Patel, Owner
(770) 715-0472
Signed By Date
1/14/2025
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