Contract Pharmacy Details

RAINBOW DRUG STORE
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

RAINBOW DRUG STORE

Pharmacy Address

4319 NEW JESUP HWY
BRUNSWICK, GA 31520-1605

Pharmacy Comments

Contract Details

Approval Date

9/21/2010

Contract Begin Date

9/21/2010

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

9/16/2010

340B Drug Pricing Program Database