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CH04306D NORTHEAST MISSISSIPPI HEALTH CARE, INC. (Active)
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Main Details
Name
NORTHEAST MISSISSIPPI HEALTH CARE, INC.
Subdivision Name
DeSoto Community Health Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-013741
340B ID
CH04306D
Grant Number
H80CS00432
Additional Details
Current Program Status
Active
Registration Date
8/6/2014
Participating Start Date
10/1/2014
Participating Approval Date
8/6/2014
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
Northeast Mississippi Health Care, Inc.
Clifton Rodgers, Physician
(662) 349-6220
Primary Contact
Northeast Mississippi Health Care, Inc.
Andrea Chrestman, COO/CCO
(662) 838-2163 Ext: 235
Addresses
Street Address
7535 Airways Boulevard
Southaven, MS 38671-5816
Billing Address
NORTHEAST MISSISSIPPI HEALTH CARE, INC.
PO BOX 698
BYHALIA, MS 38611-7000
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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