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WALGREEN CO
CHC00836-05 SOUTH CENTRAL PRIMARY CARE CENTER
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Covered Entity Details
Entity Name
SOUTH CENTRAL PRIMARY CARE CENTER
Subdivision Name
South Central Primary Care Center, Inc. - Operations Building
Type
HRSA-Funded Health Center
340B ID
CHC00836-05
Entity Address
406 W 5th St
Ocilla, GA 31774-1421
Grant Number
H80CS00836
Participating Start Date
7/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #11661
602 PETERSON AVE S
DOUGLAS, GA 31533
Pharmacy Comments
Contract Details
Approval Date
5/28/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert B. Tucker, CEO
(229) 468-9166 Ext: 1
Contract Pharmacy Representative
Walgreens
Lisa Villarreal, Analyst, 340B Operations
(847) 964-6183
Signed By Date
5/28/2015
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