Contract Pharmacy Details

NOBLE HEALTH SERVICES INC.
HM70461 Mississippi Center for Advanced Medicine

Covered Entity Details

Entity Name

Mississippi Center for Advanced Medicine

Subdivision Name

Type

Comprehensive Hemophilia Treatment Center

340B ID

HM70461

Entity Address

2053 Gause Blvd.
Suite 200
Slidell, LA 70461

Grant Number

MCHB5H30MC240460700

Participating Start Date

7/1/2019

Last Recertification Date

Entity Termination Date

7/1/2019

Pharmacy Details

Pharmacy Name

NOBLE HEALTH SERVICES INC.

Pharmacy Address

6040 TARBELL ROAD
SYRACUSE, NY 13206

Pharmacy Comments

Contract Details

Approval Date

4/11/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Spencer Sullivan, President
(601) 499-0935

Contract Pharmacy Representative

KPH Healthcare Services, Inc.
Debbi Barber, 340B Program Director
(315) 287-3600 Ext: 2423

Signed By Date

4/11/2019

340B Drug Pricing Program Database