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GOLDEN TRIANGLE PLANNING & DEVELOPMENT D
CAH251334-00 CHOCTAW REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CHOCTAW REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251334-00
Entity Address
8613 MS HWY 12
ACKERMAN, MS 39735
Medicare Provider Number
251334
Participating Start Date
7/1/2015
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
GOLDEN TRIANGLE PLANNING & DEVELOPMENT D
Pharmacy Address
PHARMACY
PO BOX 828
301 CC CLARK ROAD
STARKVILLE, MS 39759
Pharmacy Comments
Contract Details
Approval Date
7/16/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/23/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jamie Rodgers, CEO
(662) 285-4400
Contract Pharmacy Representative
Golden Triagle PPD Pharmacy
Anna Lancaster, Pharmacist
(662) 320-2011
Signed By Date
7/16/2018
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