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CH04392C MANTACHIE RURAL HEALTH CARE INC (Active)
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Main Details
Name
MANTACHIE RURAL HEALTH CARE INC
Subdivision Name
Mantachie Rural Health Care Behavioral Health Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-017348
340B ID
CH04392C
Grant Number
H80CS00096
Additional Details
Current Program Status
Active
Registration Date
1/11/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/25/2018
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
5510 Highway 363
Mantachie, MS 38855
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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May 2025
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