340B Drug Pricing Program Database
MAGIC MART PHARMACY INC
SCH250095-00 South Sunflower County Hospital - information as of 5/13/2025 2:09:23 AM
Covered Entity Details
Entity Name
South Sunflower County Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH250095-00
Entity Address
121 East Baker Street
Indianola, MS 38751-2462
Medicare Provider Number
250095
Participating Start Date
10/1/2013
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
MAGIC MART PHARMACY INC
Pharmacy Address
903 HWY 82 EAST
BUILDING G
INDIANOLA, MS 38751
Pharmacy Comments
Contract Details
Approval Date
1/15/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Courtney Phillips, Administrator/CFO
(662) 635-7200
Contract Pharmacy Representative
Rolling Fork Drug Co
Guy Phillips, President
(662) 887-4135
Signed By Date
1/15/2014
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session