Contract Pharmacy Details

MIDSOUTH MEDICAL SPECIALTIES LLC
CH046150 AARON E. HENRY COMMUNITY HEALTH SERVICES CENTER, INC.

Covered Entity Details

Entity Name

AARON E. HENRY COMMUNITY HEALTH SERVICES CENTER, INC.

Subdivision Name

AARON E. HENRY - CLARKSDALE CLINIC

Type

HRSA-Funded Health Center

340B ID

CH046150

Entity Address

800 Ohio Ave
Clarksdale, MS 38614-7200

Grant Number

H80CS00480

Participating Start Date

7/1/1998

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

MIDSOUTH MEDICAL SPECIALTIES LLC

Pharmacy Address

DBA SUPER DRUGS
1433 GOODMAN RD W
HORN LAKE, MS 38637

Pharmacy Comments

Contract Details

Approval Date

1/14/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/14/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

AURELIA JONES-TAYLOR, CEO
(662) 624-4292 Ext: 1119

Contract Pharmacy Representative

Midsouth Medical Specialties LLC Super Drugs
Eddie Obannon, Owner
(662) 280-7455

Signed By Date

1/14/2020

340B Drug Pricing Program Database