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MONTEZUMA DRUG COMPANY
CH04334Q CareConnect Health, Inc.
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Covered Entity Details
Entity Name
CareConnect Health, Inc.
Subdivision Name
CareConnect Family Practice
Type
HRSA-Funded Health Center
340B ID
CH04334Q
Entity Address
300 Medical Court
Oglethorpe, GA 31068
Grant Number
H80CS00393
Participating Start Date
4/1/2013
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
MONTEZUMA DRUG COMPANY
Pharmacy Address
112 SOUTH DOOLY STREET
MONTEZUMA, GA 31063
Pharmacy Comments
Contract Details
Approval Date
4/2/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/21/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ajay Gehlot, CEO
(229) 273-8881
Contract Pharmacy Representative
Daniel Kiser, Pharmacist
(478) 472-7561
Signed By Date
4/2/2013
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