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CRYSTAL PHARMACY LLC
CH043340 CareConnect Health, Inc.
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Covered Entity Details
Entity Name
CareConnect Health, Inc.
Subdivision Name
CareConnect Family Practice and Pediatrics
Type
HRSA-Funded Health Center
340B ID
CH043340
Entity Address
510 Alston Street
Suite A
Richland, GA 31825-1404
Grant Number
H80CS00393
Participating Start Date
4/1/2002
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
CRYSTAL PHARMACY LLC
Pharmacy Address
705 S MAIN ST
MOULTRIE, GA 31768-5432
Pharmacy Comments
Contract Details
Approval Date
4/9/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ajay Gehlot, CEO
(229) 273-8881
Contract Pharmacy Representative
Crystal Pharmacy
Scotty Crystal, Owner
(229) 985-4137
Signed By Date
4/9/2018
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