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WALGREEN CO.
CH043060 NORTHEAST MISSISSIPPI HEALTH CARE, INC.
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Covered Entity Details
Entity Name
NORTHEAST MISSISSIPPI HEALTH CARE, INC.
Subdivision Name
DBA BYHALIA FAMILY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH043060
Entity Address
12 BRUNSWICK ST
BYHALIA, MS 38611-0012
Grant Number
H80CS00432
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06754
4028 GOODMAN ROAD WEST
HORN LAKE, MS 38637
Pharmacy Comments
Contract Details
Approval Date
7/10/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clifton Rodgers, Physician
(662) 349-6220
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/10/2020
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