Contract Pharmacy Details

AZ PHARMACY, LLC
CH043060 NORTHEAST MISSISSIPPI HEALTH CARE, INC.

Covered Entity Details

Entity Name

NORTHEAST MISSISSIPPI HEALTH CARE, INC.

Subdivision Name

DBA BYHALIA FAMILY HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH043060

Entity Address

12 BRUNSWICK ST
BYHALIA, MS 38611-0012

Grant Number

H80CS00432

Participating Start Date

12/1/1992

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

AZ PHARMACY, LLC

Pharmacy Address

DBA AMAZON PHARMACY #002
3809 E WATKINS ST
PHOENIX, AZ 85034

Pharmacy Comments

Contract Details

Approval Date

1/9/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/31/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Clifton Rodgers, Physician
(662) 349-6220

Contract Pharmacy Representative

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

Signed By Date

1/9/2019

340B Drug Pricing Program Database