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SALTILLO PHARMACY
CH04392C MANTACHIE RURAL HEALTH CARE INC
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Covered Entity Details
Entity Name
MANTACHIE RURAL HEALTH CARE INC
Subdivision Name
Mantachie Rural Health Care Behavioral Health Clinic
Type
HRSA-Funded Health Center
340B ID
CH04392C
Entity Address
5510 Highway 363
Mantachie, MS 38855
Grant Number
H80CS00096
Participating Start Date
4/1/2018
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
SALTILLO PHARMACY
Pharmacy Address
2698 HWY 145
SALTILLO, MS 38866
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2020
Ownership change
Contacts
Covered Entity Signing Official
MARJORIE MCKINNEY, CEO
(662) 282-4226 Ext: 114
Contract Pharmacy Representative
Saltillo Pharmacy & Solutions
Adam White, Chief of Operations
(662) 269-2781
Signed By Date
7/15/2019
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