Contract Pharmacy Details

MANIFEST PHARMACY, LLC
CH04334L CareConnect Health, Inc.

Covered Entity Details

Entity Name

CareConnect Health, Inc.

Subdivision Name

CareConnect Family Practice

Type

HRSA-Funded Health Center

340B ID

CH04334L

Entity Address

712 N 7th St
Cordele, GA 31015-3271

Grant Number

H80CS00393

Participating Start Date

4/1/2010

Last Recertification Date

2/21/2025

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