Contract Pharmacy Details

MISSISSIPPI CVS PHARMACY, L.L.C.
CH040760 G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.

Subdivision Name

G. A. CARMICHAEL FAMILY HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH040760

Entity Address

1668 W Peace St
Canton, MS 39046-5332

Grant Number

H80CS00484

Participating Start Date

10/1/2013

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

MISSISSIPPI CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04997
305 MEADOWBROOK RD.
JACKSON, MS 39206

Pharmacy Comments

Contract Details

Approval Date

4/15/2022

Contract Begin Date

4/21/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

James L. Coleman Jr., CEO
(601) 859-5213 Ext: 2291

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/15/2022

340B Drug Pricing Program Database