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VITAL RX LLC
CH067570 CAPITOL CITY FAMILY HEALTH CENTER INC dba CARESOUTH
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Covered Entity Details
Entity Name
CAPITOL CITY FAMILY HEALTH CENTER INC dba CARESOUTH
Subdivision Name
CAPITOL CITY FAMILY HEALTH CENTER, INC dba CARESOUTH
Type
HRSA-Funded Health Center
340B ID
CH067570
Entity Address
3140 FLORIDA BLVD
BATON ROUGE, LA 70806
Grant Number
H80CS00504
Participating Start Date
10/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
VITAL RX LLC
Pharmacy Address
237 CAHABA VALLEY PARKWAY
PELHAM, AL 35124
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
2/5/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Matthew Valliere, Chief Executive Officer
(225) 650-2026
Contract Pharmacy Representative
VitalRx
Bobby Wamble, COO
(256) 260-3350
Signed By Date
4/16/2018
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