Contract Pharmacy Details

DOGWOOD PHARMACY
CH043340 CareConnect Health, Inc.

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

DOGWOOD PHARMACY

Pharmacy Address

1909 US HIGHWAY 82 W STE 11
TIFTON, GA 31793-8213

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

Dogwood Pharmacy
Gena Tyson, Owner
(229) 256-2411

Signed By Date

4/9/2018