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MISSISSIPPI CVS PHARMACY, L.L.C.
CHC12890-00 FAIRFIELD COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
FAIRFIELD COMMUNITY HEALTH CENTER
Subdivision Name
FCHC South
Type
HRSA-Funded Health Center
340B ID
CHC12890-00
Entity Address
220 E Walnut St
Lancaster, OH 43130-4464
Grant Number
H80CS19595
Participating Start Date
7/1/2010
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MISSISSIPPI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08491
2945 GOODMAN ROAD EAST
SOUTHAVEN, MS 38672
Pharmacy Comments
Contract Details
Approval Date
1/14/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kim Rase-Shuttleworth, Revenue Specialist
(740) 277-6043 Ext: 1011
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/14/2021
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