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FP388296 PRENTISS COUNTY HEALTH DEPARTMENT (Terminated)
Main Details
Name
PRENTISS COUNTY HEALTH DEPARTMENT
Subdivision Name
Type
Family Planning (Title X only)
340B ID
FP388296
Grant Number
FPHPA006475
Contacts
Authorizing Official
MSDH
Beryl Polk, Health Services Director
(601) 576-7472
Primary Contact
prentiss county health department
Lynn Pounders, OFFICE MANAGER
(662) 728-3518
Additional Details
Current Program Status
Terminated
Registration Date
7/1/2022
Participating Start Date
10/1/2022
Participating Approval Date
8/2/2022
Last Recertification Date
Termination Date
7/1/2023
Termination Reason
Failure to recertify
Addresses
Street Address
615 EAST PARKER DRIVE
BOONEVILLE, MS 38829
Billing Address
Mississippi State Departmen of Health
570 East Woodrow Wilson Blvd.
Jackson, MS 39215
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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Participating from effective date: (1/1/1998) until terminated effective date: (7/1/2022), reinstatement effective date: (10/1/2022)
08/02/2022
Participating from effective date: (1/1/1998) until terminated effective date: (7/1/2022), reinstatement effective date: (10/1/2022) 7/1/2022
07/19/2022
May 2024
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