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MISSISSIPPI CVS PHARMACY, L.L.C.
RWII39202 My Brother's Keeper, Inc.
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Covered Entity Details
Entity Name
My Brother's Keeper, Inc.
Subdivision Name
Open Arms Healthcare Center
Type
Ryan White Part B
340B ID
RWII39202
Entity Address
805 East River Place
Jackson, MS 39202
Grant Number
5X07HA00036-33-00
Participating Start Date
10/1/2017
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
MISSISSIPPI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05878
915 HIGHWAY 49 SOUTH
RICHLAND, MS 39218
Pharmacy Comments
Contract Details
Approval Date
7/14/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
June Gipson, CEO
(769) 216-2455
Contract Pharmacy Representative
CVS-Caremark
Mark Bowen, Pharmacy Executive
(401) 225-3216
Signed By Date
7/14/2019
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