Contract Pharmacy Details

MLK PHARMACY
CH040490 CURTIS V. COOPER PRIMARY HEALTH CARE, INC.

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

MLK PHARMACY

Pharmacy Address

SHIV PHARMACY, INC
718 MARTIN LUTHER KING BLVD
SUITE A
SAVANNAH, GA 31401

Pharmacy Comments

Contract Details

Approval Date

4/16/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/5/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Albert B. Grandy JR., CEO
(912) 527-1117

Contract Pharmacy Representative

HealthDeliveryRX
Paresh Patel, Pharmacist
(912) 662-0300

Signed By Date

4/16/2018

340B Drug Pricing Program Database