Contract Pharmacy Details

GATLIN'S PHARMACY
CH049100 NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.

Covered Entity Details

Entity Name

NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.

Subdivision Name

Benton Medical Center

Type

HRSA-Funded Health Center

340B ID

CH049100

Entity Address

15921 Boundary Dr
Ashland, MS 38603-7740

Grant Number

H80CS00635

Participating Start Date

9/9/2005

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

GATLIN'S PHARMACY

Pharmacy Address

18 FIRST AVE
PO BOX 369
TISHOMINGO, MS 38873-8441

Pharmacy Comments

Contract Details

Approval Date

7/1/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

JAMES D. NUNNALLY, EXECUTIVE DIRECTOR
(662) 224-8951 Ext: 230

Contract Pharmacy Representative

Medical Plaza on Harper
Bart Doran, Owner
(662) 396-6369

Signed By Date

7/1/2016

340B Drug Pricing Program Database