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WAL-MART PHARMACY 10-0708
CH040750 CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.
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Covered Entity Details
Entity Name
CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.
Subdivision Name
CENTRAL MS CIVIC IMPROVEMENT ASSOC., INC.D/B/A JACKSON-HINDS COMPREHENSIVE HEATLH CENTER MAIN SITE
Type
HRSA-Funded Health Center
340B ID
CH040750
Entity Address
3502 W Northside Dr
Jackson, MS 39213-4454
Grant Number
H80CS00084
Participating Start Date
12/1/1992
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0708
Pharmacy Address
2150 IOWA AVENUE
VICKSBURG, MS 39180
Pharmacy Comments
Contract Details
Approval Date
7/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jasmin Chapman, Chief Executive Officer
(601) 364-5142
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/12/2024
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