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ROCKY TOP PHARMACY INC DBA
CH044790 PRIMARY HEALTH CARE CENTER OF DADE, INC.
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Covered Entity Details
Entity Name
PRIMARY HEALTH CARE CENTER OF DADE, INC.
Subdivision Name
PRIMARY HEALTH CARE CENTER TRENTON
Type
HRSA-Funded Health Center
340B ID
CH044790
Entity Address
13570 N Main St
Trenton, GA 30752-2012
Grant Number
H80CS00649
Participating Start Date
1/1/1998
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
ROCKY TOP PHARMACY INC DBA
Pharmacy Address
LONGLEY PHARMACY
785 CHICKAMAUGA AVE
ROSSVILLE, GA 30741
Pharmacy Comments
Contract Details
Approval Date
2/2/2012
Contract Begin Date
2/2/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/12/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DIANA U. ALLEN, CEO
(706) 620-4494 Ext: 8549
Contract Pharmacy Representative
Jerry Grimmitt, Pharmacist
(706) 866-1220
Signed By Date
1/25/2012
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