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FAYETTE DISCOUNT DRUGS
CH048800 JEFFERSON COMPREHENSIVE HEALTH CENTER INC
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Covered Entity Details
Entity Name
JEFFERSON COMPREHENSIVE HEALTH CENTER INC
Subdivision Name
JEFFERSON COMPREHENSIVE HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH048800
Entity Address
405 Main Street
Fayette, MS 39069-0098
Grant Number
H80CS00582
Participating Start Date
12/1/1992
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
FAYETTE DISCOUNT DRUGS
Pharmacy Address
1418 MAIN ST
PO BOX 127
FAYETTE, MS 39069
Pharmacy Comments
Contract Details
Approval Date
7/23/2001
Contract Begin Date
7/23/2001
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Shirley Ellis-Stampley, CEO
(601) 786-3475
Contract Pharmacy Representative
Jefferson Coomprehensive Health Center
Shirley Ellis-Stampley, CEO
(601) 786-3475
Signed By Date
9/28/2011
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