340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-5173
CH04211P GEORGIA MOUNTAINS HEALTH SERVICES, INC.
Print
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
WAL-MART PHARMACY 10-5173
Pharmacy Address
815 SHUGART RD
DALTON(W), GA 30720
Pharmacy Comments
Contract Details
Approval Date
10/13/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/26/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steven Miracle, CEO
(706) 946-5610
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/13/2017
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session