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MANTACHIE PHARMACY, LLC
CH043920 MANTACHIE RURAL HEALTH CARE INC
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Covered Entity Details
Entity Name
MANTACHIE RURAL HEALTH CARE INC
Subdivision Name
Mantachie Rural Health Care, Inc.
Type
HRSA-Funded Health Center
340B ID
CH043920
Entity Address
5681 Highway 363
Mantachie, MS 38855-7632
Grant Number
H80CS00096
Participating Start Date
10/1/1996
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
MANTACHIE PHARMACY, LLC
Pharmacy Address
3309 HIGHWAY 371 N
MANTACHIE, MS 38855-7267
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARJORIE MCKINNEY, CEO
(662) 282-4226 Ext: 114
Contract Pharmacy Representative
Mantachie Pharmacy
katlyn Spradling, Pharmacist
(662) 322-3901
Signed By Date
10/15/2018
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