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HOMETOWN PHARMACY, LLC
CAH251302-00 BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251302-00
Entity Address
400 SOUTH CHESTNUT ST
ABERDEEN, MS 39730
Medicare Provider Number
251302
Participating Start Date
9/24/2010
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
HOMETOWN PHARMACY, LLC
Pharmacy Address
40518 OLD HIGHWAY 45 S
HAMILTON, MS 39746-9799
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
Chris Chandler, CEO
(662) 369-2455
Contract Pharmacy Representative
Hometown Pharmacy
Holly Reeves, Owner
(662) 362-7070
Signed By Date
4/17/2023
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