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THE PHARMACY AT DESOTO
CH043060 NORTHEAST MISSISSIPPI HEALTH CARE, INC.
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Covered Entity Details
Entity Name
NORTHEAST MISSISSIPPI HEALTH CARE, INC.
Subdivision Name
DBA BYHALIA FAMILY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH043060
Entity Address
12 BRUNSWICK ST
BYHALIA, MS 38611-0012
Grant Number
H80CS00432
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
THE PHARMACY AT DESOTO
Pharmacy Address
7601 SOUTHCREST PKWY
WEST ENTRANCE SUITE 100
SOUTHAVEN, MS 38671-4739
Pharmacy Comments
Contract Details
Approval Date
4/11/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clifton Rodgers, Physician
(662) 349-6220
Contract Pharmacy Representative
The Pharmacy at DeSoto
George Salem, Primary Contact
(662) 253-8206
Signed By Date
4/11/2019
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