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CITY REXALL DRUGS
DSH250117 HIGHLAND COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
HIGHLAND COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250117
Entity Address
130 Highland Parkway
PICAYUNE, MS 39466
Medicare Provider Number
250117
Participating Start Date
10/1/2007
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CITY REXALL DRUGS
Pharmacy Address
349 S MAIN ST
PICAYUNE, MS 39466-4415
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
1/6/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bryan Keith Maxie, Regional Administrator
(601) 297-0503
Contract Pharmacy Representative
City Rexall Drugs
John Griffin, Owner
(601) 798-4761
Signed By Date
10/14/2022
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