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ALLIANCE COMMUNITY PHARMACY CORPORATION
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
ALLIANCE COMMUNITY PHARMACY CORPORATION
Pharmacy Address
D/B/A ALLIANCE COMMUNITY PHARMACY
1016 PIEDMONT AVE NE
ATLANTA, GA 30309
Pharmacy Comments
Contract Details
Approval Date
7/7/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Marisol Cruz, HIV Care Program Manager
(404) 463-2453
Contract Pharmacy Representative
Alliance Community Pharmacy, Corp.
Craig Bates, CEO
(404) 461-9105
Signed By Date
7/7/2017
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