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BOONEVILLE COMMUNITY PHARMACY
CH049100 NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.
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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
BOONEVILLE COMMUNITY PHARMACY
Pharmacy Address
206 N 2ND ST
BOONEVILLE, MS 38829-2702
Pharmacy Comments
Contract Details
Approval Date
10/14/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JAMES D. NUNNALLY, EXECUTIVE DIRECTOR
(662) 224-8951 Ext: 230
Contract Pharmacy Representative
Booneville
Tony Smith, Owner/Pharmacist
(662) 728-1951
Signed By Date
10/14/2016
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