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SONSHINE PHARMACY OF MANTACHIE
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
SONSHINE PHARMACY OF MANTACHIE
Pharmacy Address
2745 HIGHWAY 371 N
MANTACHIE, MS 38855
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/25/2023
Ownership change
Contacts
Covered Entity Signing Official
MARJORIE MCKINNEY, CEO
(662) 282-4226 Ext: 114
Contract Pharmacy Representative
SONSHINE PHARMACY OF MANTACHIE
TRINITY NICHOLS, OWNER
(662) 282-5757
Signed By Date
10/15/2019
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