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THOMAS PHARMACY PINE TREE VILLAGE
CH040570 FAMILY HEALTH CENTER INC
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTER INC
Subdivision Name
FAMILY HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH040570
Entity Address
117 S 11th Ave
Laurel, MS 39440-4312
Grant Number
H80CS00538
Participating Start Date
10/1/1995
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
THOMAS PHARMACY PINE TREE VILLAGE
Pharmacy Address
THOMAS PHARMACY
2341 HIGHWAY 15 N
PO BOX 4111
LAUREL, MS 39440
Pharmacy Comments
Contract Details
Approval Date
5/20/2022
Contract Begin Date
5/20/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Rashad Ali, CEO
(601) 425-3033 Ext: 156
Contract Pharmacy Representative
Thomas Pharmacy
Stephanie M Lovett, Pharmacist
(601) 518-3590 Ext: 202
Signed By Date
5/20/2022
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