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MISSISSIPPI CVS PHARMACY, L.L.C.
CH045770 Southeast Mississippi Rural Health Initiative, Inc.
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Covered Entity Details
Entity Name
Southeast Mississippi Rural Health Initiative, Inc.
Subdivision Name
SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.
Type
HRSA-Funded Health Center
340B ID
CH045770
Entity Address
5488 U S Highway 49
Hattiesburg, MS 39401-7806
Grant Number
H80CS00610
Participating Start Date
10/1/2002
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
MISSISSIPPI CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 17144
6143 U S HIGHWAY 98 STE 80
HATTIESBURG, MS 39402
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
GEROLDEAN DYSE, CEO
(601) 545-8700
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2019
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