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JONES COUNTY DRUG INC
DSH250058 SOUTH CENTRAL REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250058
Entity Address
1220 JEFFERSON STREET
LAUREL, MS 39440
Medicare Provider Number
250058
Participating Start Date
7/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
JONES COUNTY DRUG INC
Pharmacy Address
407 HILL ST
ELLISVILLE, MS 39437
Pharmacy Comments
Contract Details
Approval Date
10/7/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James T. Canizaro, CFO
(601) 399-6139
Contract Pharmacy Representative
Jones County Drug
Jay Scoggin, Owner
(601) 477-3030
Signed By Date
10/7/2024
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