340B Drug Pricing Program Database
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PANOLA PHARMACY, LLC
DSH250128 PANOLA MEDICAL CENTER
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Covered Entity Details
Entity Name
PANOLA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250128
Entity Address
303 MEDICAL CENTER DRIVE
BATESVILLE, MS 38606
Medicare Provider Number
250128
Participating Start Date
7/1/2021
Last Recertification Date
8/31/2022
Entity Termination Date
10/1/2023
Pharmacy Details
Pharmacy Name
PANOLA PHARMACY, LLC
Pharmacy Address
440 HIGHWAY 6 E
BATESVILLE, MS 38606
Pharmacy Comments
Contract Details
Approval Date
10/20/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Quentin Q Whitwell, CEO
(662) 712-1515
Contract Pharmacy Representative
Panola Pharmacy
Jennifer Sullivant, owner
(662) 855-1204
Signed By Date
10/20/2022
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