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DELIVERCARERX PHARMACY LLC
CH045260 PALMETTO HEALTH COUNCIL, INC
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Covered Entity Details
Entity Name
PALMETTO HEALTH COUNCIL, INC
Subdivision Name
YourTown Health
Type
HRSA-Funded Health Center
340B ID
CH045260
Entity Address
643 Main St
Palmetto, GA 30268-1138
Grant Number
H80CS00460
Participating Start Date
4/1/2008
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
DELIVERCARERX PHARMACY LLC
Pharmacy Address
DELIVERCARERX PHARMACY LLC
1471 E BUSINESS CENTER DR
STE 200
MT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
10/12/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jon W. Wollenzien Jr., CEO
(404) 929-8824 Ext: 222
Contract Pharmacy Representative
Agape
Dave Krishna, CEO
(847) 965-1600
Signed By Date
10/12/2016
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