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WAL-MART PHARMACY 10-0303
CH04306C NORTHEAST MISSISSIPPI HEALTH CARE, INC.
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Covered Entity Details
Entity Name
NORTHEAST MISSISSIPPI HEALTH CARE, INC.
Subdivision Name
BYHALIA FAMILY DENTAL CLINIC
Type
HRSA-Funded Health Center
340B ID
CH04306C
Entity Address
34 Brunswick Street
Byhalia, MS 38611-0698
Grant Number
H80CS00432
Participating Start Date
10/1/2011
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0303
Pharmacy Address
950 MACKIE DR
HOLLY SPRINGS, MS 38635
Pharmacy Comments
Contract Details
Approval Date
2/15/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clifton Rodgers, Physician
(662) 349-6220
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
2/15/2023
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