Contract Pharmacy Details

POMANK VENTURES
CH045770 Southeast Mississippi Rural Health Initiative, Inc.

Covered Entity Details

Entity Name

Southeast Mississippi Rural Health Initiative, Inc.

Subdivision Name

SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.

Type

HRSA-Funded Health Center

340B ID

CH045770

Entity Address

5488 U S Highway 49
Hattiesburg, MS 39401-7806

Grant Number

H80CS00610

Participating Start Date

10/1/2002

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

POMANK VENTURES

Pharmacy Address

DBA FAIRVIEW PHARMACY AND COMPOUNDING
500 KATIE AVE
HATTIESBURG, MS 39401

Pharmacy Comments

Contract Details

Approval Date

7/10/2018

Contract Begin Date

7/10/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

GEROLDEAN DYSE, CEO
(601) 545-8700

Contract Pharmacy Representative

FAIRVIEW PHARMACY
LANIKA ELLIS, POC
(601) 544-4871

Signed By Date

7/10/2018

340B Drug Pricing Program Database