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APAA LLC
CH04901I EAST GEORGIA HEALTHCARE CENTER, INC.
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Covered Entity Details
Entity Name
EAST GEORGIA HEALTHCARE CENTER, INC.
Subdivision Name
East Georgia Healthcare Pediatrics Office
Type
HRSA-Funded Health Center
340B ID
CH04901I
Entity Address
125 B Victory Dr
Swainsboro, GA 30401-3234
Grant Number
H80CS00512
Participating Start Date
1/1/2009
Last Recertification Date
1/27/2017
Entity Termination Date
7/1/2017
Pharmacy Details
Pharmacy Name
APAA LLC
Pharmacy Address
D/B/A HOLIDAY PHARMACY
6815 N. DALE MABRY HIGHWAY
TAMPA, FL 33614
Pharmacy Comments
Contract Details
Approval Date
10/7/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Contacts
Covered Entity Signing Official
JENNIE WREN DENMARK, CEO
(478) 237-6262 Ext: 107
Contract Pharmacy Representative
Brian Martin, Pharmacy Manager
(813) 956-0292
Signed By Date
10/7/2013
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