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LIBERTY DRUG STORE
CH04578A AMITE COUNTY MEDICAL SERVICES, INC.
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Covered Entity Details
Entity Name
AMITE COUNTY MEDICAL SERVICES, INC.
Subdivision Name
Pike County Medical Services
Type
HRSA-Funded Health Center
340B ID
CH04578A
Entity Address
303 LLewellyn Ave
McComb, MS 39648
Grant Number
H80CS00609
Participating Start Date
4/1/2016
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
LIBERTY DRUG STORE
Pharmacy Address
P.O. BOX 217
110 MAIN STREET
LIBERTY, MS 39645
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
Baili Harvey, Finance Director
(601) 657-4326
Contract Pharmacy Representative
Liberty
Ron Blalock, Owner
(601) 657-8051
Signed By Date
4/17/2023
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