Contract Pharmacy Details

MEDICAL CENTER PRESCRIPTION
CH04334F CareConnect Health, Inc.

Covered Entity Details

Entity Name

CareConnect Health, Inc.

Subdivision Name

Eastman Medical Center

Type

HRSA-Funded Health Center

340B ID

CH04334F

Entity Address

1111 Griffin Avenue, Suite A
Eastman, GA 31023

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

MEDICAL CENTER PRESCRIPTION

Pharmacy Address

MEDICAL CENTER PRESCRIPTION SHOP
710 MEDICAL CENTER DR
EASTMAN, GA 31023-6736

Pharmacy Comments

Contract Details

Approval Date

9/9/2011

Contract Begin Date

9/9/2011

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/5/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Ajay Gehlot, CEO
(229) 942-8309

Contract Pharmacy Representative

Freddie Dwozan, CEO
(478) 374-6662

Signed By Date

8/25/2011

340B Drug Pricing Program Database