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SMITH DRUGS OF BOONEVILLE LLC
CH04910K NORTH MS PRIMARY HEALTH CARE INC
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Covered Entity Details
Entity Name
NORTH MS PRIMARY HEALTH CARE INC
Subdivision Name
Walnut Imaging Center
Type
HRSA-Funded Health Center
340B ID
CH04910K
Entity Address
71 Mitchell Ave
Walnut, MS 38683
Grant Number
H80CS00635
Participating Start Date
10/1/2023
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
SMITH DRUGS OF BOONEVILLE LLC
Pharmacy Address
DBA/ SMITH DRUG & HOME MEDICAL
100 S SECOND ST
BOONEVILLE, MS 38829-3225
Pharmacy Comments
Contract Details
Approval Date
1/10/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bill Stone, CEO
(662) 502-3149
Contract Pharmacy Representative
Smith Drug & Home Medical
Michael Murphy, Owner
(662) 728-5322
Signed By Date
1/10/2024
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