Contract Pharmacy Details

DEBERRY DRUGS
RRC250009-00 MAGNOLIA REGIONAL HEALTH CENTER

Covered Entity Details

Entity Name

MAGNOLIA REGIONAL HEALTH CENTER

Subdivision Name

Type

Rural Referral Center

340B ID

RRC250009-00

Entity Address

611 ALCORN DRIVE
CORINTH, MS 38834

Medicare Provider Number

250009

Participating Start Date

4/1/2017

Last Recertification Date

8/15/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

DEBERRY DRUGS

Pharmacy Address

834 MULBERRY AVE
SELMER, TN 38375

Pharmacy Comments

Contract Details

Approval Date

7/16/2024

Contract Begin Date

10/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Stephen Ray Thames, CFO
(662) 293-7647

Contract Pharmacy Representative

Deberry Drugs
Clint Smith, Manager
(731) 645-6100

Signed By Date

7/16/2024