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APAA LLC
CH04040A Southside Medical Center, Inc.
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Covered Entity Details
Entity Name
Southside Medical Center, Inc.
Subdivision Name
SOUTHSIDE MEDICAL CENTER - Gresham Clinic
Type
HRSA-Funded Health Center
340B ID
CH04040A
Entity Address
2578 Gresham Rd SE
Atlanta, GA 30316-4138
Grant Number
H80CS00576
Participating Start Date
4/1/2010
Last Recertification Date
2/10/2025
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
7/15/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DAVID M. WILLIAMS, CEO
(404) 688-1350
Contract Pharmacy Representative
Brian Martin, Pharmacy Manager
(813) 956-0292
Signed By Date
7/15/2013
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