Contract Pharmacy Details

WALGREEN CO
FQHCLA318 NORTH GEORGIA HEALTHCARE CENTER, INC.

Covered Entity Details

Entity Name

NORTH GEORGIA HEALTHCARE CENTER, INC.

Subdivision Name

North Georgia Healthcare Center

Type

Health Center Program Look-Alike

340B ID

FQHCLA318

Entity Address

6120 Alabama Hwy
Ringgold, GA 30736-2804

Grant Number

LALCS00145

Participating Start Date

1/1/2014

Last Recertification Date

1/28/2015

Entity Termination Date

1/1/2016

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA: WALGREENS #10247
5075 ALABAMA HWY
RINGGOLD, GA 30736

Pharmacy Comments

Contract Details

Approval Date

4/2/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2016
Covered Entity Terminated

Contacts

Covered Entity Signing Official

DeLaine Hunter, CEO
(706) 935-6442

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/2/2015

340B Drug Pricing Program Database