Contract Pharmacy Details

PILLPACK LLC
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

PILLPACK LLC

Pharmacy Address

DBA PILLPACK BY AMAZON PHARMACY
250 COMMERCIAL ST STE 2012
MANCHESTER, NH 03101

Pharmacy Comments

Contract Details

Approval Date

7/13/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

GEROLDEAN DYSE, CEO
(601) 545-8700

Contract Pharmacy Representative

PillPack, Inc.
Geoff Swindle, Administrator
(855) 745-5725

Signed By Date

7/13/2018

340B Drug Pricing Program Database