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CH04392D 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. School Based Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-027986
340B ID
CH04392D
Grant Number
H80CS00096
Additional Details
Current Program Status
Active
Registration Date
4/5/2022
Participating Start Date
7/1/2022
Participating Approval Date
4/12/2022
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
311 Mustang Dr
Mantachie, MS 38855
Billing Address
Mantachie Rural Health Care, Inc.
P.O. Box 40
Mantachie, MS 38855
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
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