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HOLLIS DISCOUNT 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
HOLLIS DISCOUNT PHARMACY
Pharmacy Address
1008 CITY AVE N
RIPLEY, MS 38663-1413
Pharmacy Comments
Contract Details
Approval Date
10/14/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/22/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JAMES D. NUNNALLY, EXECUTIVE DIRECTOR
(662) 224-8951 Ext: 230
Contract Pharmacy Representative
Marshall Hollis, Owner
(662) 837-7323
Signed By Date
10/14/2016
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