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MISSISSIPPI CVS PHARMACY, L.L.C.
CH043920 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, Inc.
Type
HRSA-Funded Health Center
340B ID
CH043920
Entity Address
5681 Highway 363
Mantachie, MS 38855-7632
Grant Number
H80CS00096
Participating Start Date
10/1/1996
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
MISSISSIPPI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04536
301 AMERICAN AVENUE
BOONEVILLE, MS 38829
Pharmacy Comments
Contract Details
Approval Date
7/20/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARJORIE MCKINNEY, CEO
(662) 282-4226 Ext: 114
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/20/2020
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