Contract Pharmacy Details

BARNES DRUG STORES OF VALDOSTA, INC
RWIID303031 GEORGIA DEPT OF PUBLIC HEALTH

Covered Entity Details

Entity Name

GEORGIA DEPT OF PUBLIC HEALTH

Subdivision Name

Type

Ryan White Part B ADAP Direct Purchase

340B ID

RWIID303031

Entity Address

200 Piedmont Ave. SE
West Tower
Suite 1508
ATLANTA, GA 30334

Grant Number

X07HA22709

Participating Start Date

4/1/1997

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

BARNES DRUG STORES OF VALDOSTA, INC

Pharmacy Address

DBA BARNES DRUG STORE
200 S PATTERSON ST
VALDOSTA, GA 31601-5621

Pharmacy Comments

2/16/11 UPDATED ADDR (WAS 1311 NORTH PATTERSON STREET);

Contract Details

Approval Date

11/4/2010

Contract Begin Date

12/1/2010

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

MARISOL CRUZ, HIV CARE PROGRAM MANAGER
(404) 463-2453

Contract Pharmacy Representative

Barnes Drug Store
Caroline Barnes, Pharmacist
(229) 242-1925

Signed By Date

11/1/2010

340B Drug Pricing Program Database