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WAL-MART PHARMACY 10-0605
CH040490 CURTIS V. COOPER PRIMARY HEALTH CARE, INC.
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Covered Entity Details
Entity Name
CURTIS V. COOPER PRIMARY HEALTH CARE, INC.
Subdivision Name
FORMERLY WESTSIDE URBAN HLTH CTRS, INC.
Type
HRSA-Funded Health Center
340B ID
CH040490
Entity Address
106 EAST BROAD STREET
SAVANNAH, GA 31401
Grant Number
H80CS00082
Participating Start Date
12/1/1992
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0605
Pharmacy Address
1955 EAST MONTGOMERY CROSSROAD
SAVANNAH, GA 31406
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Albert B. Grandy JR., CEO
(912) 527-1117
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/15/2018
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