Contract Pharmacy Details

MANIFEST PHARMACY, LLC
CH04334A CareConnect Health, Inc.

Covered Entity Details

Entity Name

CareConnect Health, Inc.

Subdivision Name

Plains Medical Center

Type

HRSA-Funded Health Center

340B ID

CH04334A

Entity Address

107 Main St
Plains, GA 31780-5570

Grant Number

H80CS00393

Participating Start Date

1/1/2010

Last Recertification Date

2/8/2018

Entity Termination Date

7/1/2018

Pharmacy Details

Pharmacy Name

MANIFEST PHARMACY, LLC

Pharmacy Address

1018 S BATESVILLE RD
STE 4A
GREER, SC 29650-5203

Pharmacy Comments

Contract Details

Approval Date

4/10/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/16/2015
Pharmacy closed

Contacts

Covered Entity Signing Official

Ajay Gehlot, CEO
(229) 273-8881

Contract Pharmacy Representative

Benjamin Walvoord, President
(864) 990-2880

Signed By Date

4/10/2013