Contract Pharmacy Details

EAST MARIETTA DRUG CO 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

EAST MARIETTA DRUG CO INC

Pharmacy Address

1480 ROSWELL RD
MARIETTA, GA 30062

Pharmacy Comments

Contract Details

Approval Date

7/1/2006

Contract Begin Date

7/1/2006

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Signed By Date

3/28/2006

340B Drug Pricing Program Database