Contract Pharmacy Details

APAA LLC
CH04040D Southside Medical Center, Inc.

Covered Entity Details

Entity Name

Southside Medical Center, Inc.

Subdivision Name

SOUTHSIDE MEDICAL CENTER - Windy Hill Clinic

Type

HRSA-Funded Health Center

340B ID

CH04040D

Entity Address

578 Windy Hill Rd SE
Smyrna, GA 30080-1367

Grant Number

H80CS00576

Participating Start Date

4/1/2010

Last Recertification Date

2/15/2019

Entity Termination Date

7/1/2019

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

Contract Termination Date
Termination Reason

7/1/2019
Covered Entity Terminated

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