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WALGREEN CO.
CH045780 AMITE COUNTY MEDICAL SERVICES, INC.
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Covered Entity Details
Entity Name
AMITE COUNTY MEDICAL SERVICES, INC.
Subdivision Name
AMITE COUNTY MEDICAL SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH045780
Entity Address
102 WEST FREEDOM DRIVE
LIBERTY, MS 39645-0511
Grant Number
H80CS00609
Participating Start Date
7/1/2002
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17350
1703 DELAWARE AVE
MCCOMB, MS 39648
Pharmacy Comments
Contract Details
Approval Date
4/10/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Pam T. Poole, Executive Director
(601) 657-4326 Ext: 126
Contract Pharmacy Representative
Walgreens
Lisa Villarreal, Analyst, 340B Operations
(847) 964-6183
Signed By Date
4/10/2019
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