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BELMONT PHARMACY, LLC
CH049100 NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.
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Covered Entity Details
Entity Name
NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.
Subdivision Name
Benton Medical Center
Type
HRSA-Funded Health Center
340B ID
CH049100
Entity Address
15921 Boundary Dr
Ashland, MS 38603-7740
Grant Number
H80CS00635
Participating Start Date
9/9/2005
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
BELMONT PHARMACY, LLC
Pharmacy Address
338 2ND ST
PO BOX 876
BELMONT, MS 38827
Pharmacy Comments
Contract Details
Approval Date
4/17/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Miles D Nunnally, Chief Executive Officer
(662) 502-3140
Contract Pharmacy Representative
belmont Pharmacy
William Weatherford, Owner
(662) 454-9902
Signed By Date
4/17/2023
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