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MISSISSIPPI CVS PHARMACY, L.L.C.
CH040780 DELTA HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
DELTA HEALTH CENTER, INC.
Subdivision Name
DELTA HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH040780
Entity Address
702 MARTIN L. KING ROAD
MOUND BAYOU, MS 38762-0900
Grant Number
H80CS00085
Participating Start Date
12/1/1992
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
MISSISSIPPI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05808
760 S MARTIN LUTHER KING HWY
GREENVILLE, MS 38701
Pharmacy Comments
Contract Details
Approval Date
7/14/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John A. Fairman, CEO
(662) 741-8880
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2023
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