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KROGER DRUGSTORE
CH045211C FIRST CHOICE PRIMARY CARE, INC.
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Covered Entity Details
Entity Name
FIRST CHOICE PRIMARY CARE, INC.
Subdivision Name
Ingram Pye Health Center
Type
HRSA-Funded Health Center
340B ID
CH045211C
Entity Address
855 Anthony Rd
Macon, GA 31204-6266
Grant Number
H80CS08242
Participating Start Date
1/1/2016
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
KROGER DRUGSTORE
Pharmacy Address
#410
400 PIO NONO AVENUE
MACON, GA 31204
Pharmacy Comments
Contract Details
Approval Date
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Katherine McLeod, CEO
(478) 254-7204
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/14/2017
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