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ABITACARE LLC
CH045770 Southeast Mississippi Rural Health Initiative, Inc.
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Covered Entity Details
Entity Name
Southeast Mississippi Rural Health Initiative, Inc.
Subdivision Name
SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.
Type
HRSA-Funded Health Center
340B ID
CH045770
Entity Address
5488 U S Highway 49
Hattiesburg, MS 39401-7806
Grant Number
H80CS00610
Participating Start Date
10/1/2002
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
ABITACARE LLC
Pharmacy Address
D/B/A VITAL CARE RX
1501 23RD AVE
SUITE B
MERIDIAN, MS 39301
Pharmacy Comments
Contract Details
Approval Date
4/5/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GEROLDEAN DYSE, CEO
(601) 545-8700
Contract Pharmacy Representative
Abitacare LLC
Brad Gilchrist, COO
(601) 482-4003
Signed By Date
4/5/2019
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