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LOUISIANA CVS PHARMACY, L.L.C.
CH04608B CENTRAL MISSISSIPPI HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
CENTRAL MISSISSIPPI HEALTH SERVICES, INC.
Subdivision Name
CENTRAL MISSISSIPPI HLTH SERVICE
Type
HRSA-Funded Health Center
340B ID
CH04608B
Entity Address
5429 Robinson Road Ext
Jackson, MS 39204-4138
Grant Number
H80CS00860
Participating Start Date
12/1/2005
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
LOUISIANA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05354
1624 N. BURNSIDE
GONZALES, LA 70737
Pharmacy Comments
Contract Details
Approval Date
4/1/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Smith, MD
(601) 948-5572
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/1/2022
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