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NORCROSS PHARMACY
RWI30309 Positive Impact Health Centers, Inc.
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Covered Entity Details
Entity Name
Positive Impact Health Centers, Inc.
Subdivision Name
Type
Ryan White Part A
340B ID
RWI30309
Entity Address
523 Church St
Decatur, GA 30030
Grant Number
H89HA00007
Participating Start Date
7/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
NORCROSS PHARMACY
Pharmacy Address
2625 BEAVER RUIN RD
NORCROSS, GA 30071-4136
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Larry M. Lehman, CEO
(678) 990-6450 Ext: 450
Contract Pharmacy Representative
Gerri Hankla, Pharmacist
(770) 448-2288
Signed By Date
7/17/2017
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