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GEORGIA CVS PHARMACY, L.L.C.
CAH111306-00 EFFINGHAM HEALTH SYSTEM
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Covered Entity Details
Entity Name
EFFINGHAM HEALTH SYSTEM
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH111306-00
Entity Address
459 HIGHWAY 119 SOUTH
SPRINGFIELD, GA 31329-3021
Medicare Provider Number
111306
Participating Start Date
1/1/2011
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
GEORGIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07758
410 S. COLUMBIA AVE.
RINCON, GA 31326
Pharmacy Comments
Contract Details
Approval Date
4/10/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Peyton A. Smith, CFO
(912) 856-6331
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
4/10/2014
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