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CH04392B MANTACHIE RURAL HEALTH CARE INC (Active)
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Main Details
Name
MANTACHIE RURAL HEALTH CARE INC
Subdivision Name
MANTACHIE RURAL HEALTH CARE, INC. DENTAL
Type
HRSA-Funded Health Center
Site ID
BPS-H80-003665
340B ID
CH04392B
Grant Number
H80CS00096
Additional Details
Current Program Status
Active
Registration Date
1/13/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/10/2016
Last Recertification Date
2/24/2025
Contacts
Authorizing Official
Mantachie Rural Health Care INc
james h jackson jr, CEO
(662) 282-4229
Primary Contact
Mantachie Rural Health Care Inc
Karen Burns, Office Manager
(662) 282-4229
Addresses
Street Address
5500 Highway 363
Mantachie, MS 38855-7197
Billing Address
MANTACHIE RURAL HEALTH CARE, INC.
PO BOX 40
MANTACHIE, MS 38855-7632
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
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