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GATLIN'S PHARMACY
CH04910B NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.
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Covered Entity Details
Entity Name
NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.
Subdivision Name
Ripley Health Care Associates
Type
HRSA-Funded Health Center
340B ID
CH04910B
Entity Address
749 S Line St
RIPLEY, MS 38663
Grant Number
H80CS00635
Participating Start Date
4/1/2006
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
GATLIN'S PHARMACY
Pharmacy Address
18 FIRST AVE
PO BOX 369
TISHOMINGO, MS 38873-8441
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
Bill Stone, CEO
(662) 502-3149
Contract Pharmacy Representative
Medical Plaza on Harper
Bart Doran, Owner
(662) 396-6369
Signed By Date
10/16/2023
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