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SMALL TOWN PHARMACY
CH04842B Claiborne County Family Health Center
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Covered Entity Details
Entity Name
Claiborne County Family Health Center
Subdivision Name
CCFHC-A.W. WATSON SBH
Type
HRSA-Funded Health Center
340B ID
CH04842B
Entity Address
880 Anthony St
Port Gibson, MS 39150-2050
Grant Number
H80CS00482
Participating Start Date
1/1/2022
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
SMALL TOWN PHARMACY
Pharmacy Address
1005 MARKET ST
P.O. BOX 1024
PORT GIBSON, MS 39150
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LaDonna Davis, COO
(601) 437-3052 Ext: 6014373050
Contract Pharmacy Representative
Small Town Pharmacy
Sherri Collins, Owner
(601) 437-5121
Signed By Date
10/16/2023
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