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MISSISSIPPI CVS PHARMACY, L.L.C.
STD39216 My Brother's Keeper, Inc.
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Covered Entity Details
Entity Name
My Brother's Keeper, Inc.
Subdivision Name
Open Arms Healthcare Center
Type
Sexually Transmitted Diseases
340B ID
STD39216
Entity Address
805 E. River Place
Jackson, MS 39206
Grant Number
NU65PS923762
Participating Start Date
4/1/2014
Last Recertification Date
5/6/2025
Pharmacy Details
Pharmacy Name
MISSISSIPPI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05865
112 STRIBLING LN
BRANDON, MS 39042
Pharmacy Comments
Contract Details
Approval Date
10/14/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
June Gipson, CEO
(769) 216-2455
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2023
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