Contract Pharmacy Details

30A INNOVATIONS,LLC
CH045770 Southeast Mississippi Rural Health Initiative, Inc.

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

30A INNOVATIONS,LLC

Pharmacy Address

FREEDOM PHARMACY
3902 HARDY STREET
HATTIESBURG, MS 39402

Pharmacy Comments

Contract Details

Approval Date

10/7/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

GEROLDEAN DYSE, CEO
(601) 545-8700

Contract Pharmacy Representative

30AInnovations, LLS Freedom Pharmacy
Michelle Scoggin, Owner
(601) 450-6979

Signed By Date

10/7/2020

340B Drug Pricing Program Database