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WAL-MART PHARMACY 10-0874
CH048800 JEFFERSON COMPREHENSIVE HEALTH CENTER INC
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Covered Entity Details
Entity Name
JEFFERSON COMPREHENSIVE HEALTH CENTER INC
Subdivision Name
JEFFERSON COMPREHENSIVE HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH048800
Entity Address
405 Main Street
Fayette, MS 39069-0098
Grant Number
H80CS00582
Participating Start Date
12/1/1992
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0874
Pharmacy Address
314 SGT. S. PRENTISS DR
NATCHEZ, MS 39120
Pharmacy Comments
Contract Details
Approval Date
4/4/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shirley Ellis-Stampley, Chief Executive Officer
(601) 786-3475
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/4/2019
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