Contract Pharmacy Details

SMITH DRUG & HOME MEDICAL,INC
CH049100 NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.

Covered Entity Details

Entity Name

NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.

Subdivision Name

Benton Medical Center

Type

HRSA-Funded Health Center

340B ID

CH049100

Entity Address

15921 Boundary Dr
Ashland, MS 38603-7740

Grant Number

H80CS00635

Participating Start Date

9/9/2005

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

SMITH DRUG & HOME MEDICAL,INC

Pharmacy Address

100 S SECOND ST
BOONEVILLE, MS 38829

Pharmacy Comments

Contract Details

Approval Date

4/1/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/23/2019
Ownership change

Contacts

Covered Entity Signing Official

JAMES D. NUNNALLY, EXECUTIVE DIRECTOR
(662) 224-8951 Ext: 230

Contract Pharmacy Representative

Smith Drug & Home Medical,Inc
Jason White, Owner
(662) 728-5322

Signed By Date

4/1/2019

340B Drug Pricing Program Database