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FAMILY PHARMACY
CH04211P GEORGIA MOUNTAINS HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
GEORGIA MOUNTAINS HEALTH SERVICES, INC.
Subdivision Name
Fannin County Medical and Admin consolidated site
Type
HRSA-Funded Health Center
340B ID
CH04211P
Entity Address
165 Blue Ridge Overlook
Blue Ridge, GA 30513-4431
Grant Number
H80CS00093
Participating Start Date
4/1/2014
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
FAMILY PHARMACY
Pharmacy Address
1100 E WALNUT AVE STE 17
DALTON, GA 30721
Pharmacy Comments
Contract Details
Approval Date
4/13/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/4/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steven Miracle, CEO
(706) 946-5610
Contract Pharmacy Representative
Tracey Dailey, President
(706) 226-6000
Signed By Date
4/13/2015
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