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SCOTTS PHARMACY #1
RWIID303031 GEORGIA DEPT OF PUBLIC HEALTH
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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
SCOTTS PHARMACY #1
Pharmacy Address
635 PIO NONO AVENUE
MACON, GA 31204
Pharmacy Comments
Contract Details
Approval Date
7/1/2006
Contract Begin Date
7/1/2006
Carve-In Effective Date
Contract Comments
06/29/09 ADDRESS CHANGED FROM 860 PIO NONO AVE. PHARMACY MOVED TO NEW LOCATION ACROSS THE STREET; 1/29/08 PHARMACY NAME CHANGE (WAS THE MEDICINE SHOPPE)
Contacts
Covered Entity Signing Official
MARISOL CRUZ, HIV CARE PROGRAM MANAGER
(404) 463-2453
Contract Pharmacy Representative
Signed By Date
6/6/2006
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