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MISSISSIPPI CVS PHARMACY, L.L.C.
CAH251318-00 NORTH SUNFLOWER MEDICAL CENTER
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Covered Entity Details
Entity Name
NORTH SUNFLOWER MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251318-00
Entity Address
840 NORTH OAK AVENUE
RULEVILLE, MS 38771
Medicare Provider Number
251318
Participating Start Date
9/16/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
MISSISSIPPI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05801
212 W. PARK AVE.
GREENWOOD, MS 38930
Pharmacy Comments
Contract Details
Approval Date
4/14/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sam Miller, Chief Executive Officer
(662) 721-0186
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/14/2025
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