340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
ELIXIR PHARMACY, LLC
CAH251326-00 Jefferson Davis Community Hospital
Print
Covered Entity Details
Entity Name
Jefferson Davis Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251326-00
Entity Address
1102 Rose Street
Prentiss, MS 39474
Medicare Provider Number
251326
Participating Start Date
4/1/2014
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
ELIXIR PHARMACY, LLC
Pharmacy Address
7835 FREEDOM AVE NW
NORTH CANTON, OH 44720
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bryan Keith Maxie, Regional Administrator
(601) 297-0503
Contract Pharmacy Representative
Elixir Pharmacy LLC
Bill Trexler, Vice President Finance
(877) 437-9012
Signed By Date
10/14/2022
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session