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MISSISSIPPI CVS PHARMACY, L.L.C.
CAH251308-00 PONTOTOC HEALTH SERVICES
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Covered Entity Details
Entity Name
PONTOTOC HEALTH SERVICES
Subdivision Name
PONTOTOC HEALTH SERVICES
Type
Critical Access Hospital
340B ID
CAH251308-00
Entity Address
176 SOUTH MAIN
PONTOTOC, MS 38863
Medicare Provider Number
251308
Participating Start Date
1/1/2015
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
MISSISSIPPI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 8273
750 CITY AVE SOUTH
RIPLEY, MS 38663
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
11/4/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRUCE J. TOPPIN, GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY
(662) 377-4229
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2021
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