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SOUTH CENTRAL SPECIALTY PHARMACY
CAH251325-00 COVINGTON COUNTY HOSPITAL
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Covered Entity Details
Entity Name
COVINGTON COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251325-00
Entity Address
701 SOUTH HOLLY STREET
COLLINS, MS 39428
Medicare Provider Number
251325
Participating Start Date
8/18/2010
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
SOUTH CENTRAL SPECIALTY PHARMACY
Pharmacy Address
1220 JEFFERSON ST
LAUREL, MS 39440
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
Gregg Gibbes, CEO
(601) 765-6711
Contract Pharmacy Representative
South Central Regional Medical Center
James T. Canizaro, CFO
(601) 399-6139
Signed By Date
10/16/2023
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