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WALMART PHARMACY 10-6964
CH043060 NORTHEAST MISSISSIPPI HEALTH CARE, INC.
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Covered Entity Details
Entity Name
NORTHEAST MISSISSIPPI HEALTH CARE, INC.
Subdivision Name
DBA BYHALIA FAMILY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH043060
Entity Address
12 BRUNSWICK ST
BYHALIA, MS 38611-0012
Grant Number
H80CS00432
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-6964
Pharmacy Address
4150 GOODMAN ROAD WEST
HORN LAKE, MS 38637
Pharmacy Comments
Contract Details
Approval Date
4/1/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clifton Rodgers, Physician
(662) 349-6220
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/1/2024
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