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PHARMBLUE NORTH CAROLINA LLC
CH04392B 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. DENTAL
Type
HRSA-Funded Health Center
340B ID
CH04392B
Entity Address
5500 Highway 363
Mantachie, MS 38855-7197
Grant Number
H80CS00096
Participating Start Date
4/1/2016
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE NORTH CAROLINA LLC
Pharmacy Address
300 N GRACE ST.
SUITE 150
ROCKY MOUNT, NC 27804
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
MARJORIE MCKINNEY, CEO
(662) 282-4226 Ext: 114
Contract Pharmacy Representative
PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033
Signed By Date
10/15/2020
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