Contract Pharmacy Details

M.N. PHARMACY LLC
CH044369A PRIMARY CARE OF SOUTHWEST GEORGIA, INC.

Covered Entity Details

Entity Name

PRIMARY CARE OF SOUTHWEST GEORGIA, INC.

Subdivision Name

Type

HRSA-Funded Health Center

340B ID

CH044369A

Entity Address

360 COLLEGE STREET
BLAKELY, GA 39823

Grant Number

H80CS06454

Participating Start Date

12/6/2005

Last Recertification Date

2/21/2025

Pharmacy Details

Pharmacy Name

M.N. PHARMACY LLC

Pharmacy Address

DBA AMAZON PHARMACY #003
6701 NW 7TH ST., STE. #199
MIAMI, FL 33126

Pharmacy Comments

Contract Details

Approval Date

1/12/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/10/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

ANN ADDISON, CEO
(229) 723-2660

Contract Pharmacy Representative

PillPack, Inc.
Geoff Swindle, Administrator
(855) 745-5725

Signed By Date

1/12/2018

340B Drug Pricing Program Database