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MISSISSIPPI CVS PHARMACY, L.L.C.
CH046080 CENTRAL MISSISSIPPI HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
CENTRAL MISSISSIPPI HEALTH SERVICES, INC.
Subdivision Name
CENTRAL MISSISSIPPI HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH046080
Entity Address
1134 Winter St
Jackson, MS 39204-2841
Grant Number
H80CS00860
Participating Start Date
7/1/1996
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
MISSISSIPPI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05756
1420 CANTON MART RD.
JACKSON, MS 39211
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Smith, MD
(601) 948-5572
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2019
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