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FRED'S PHARMACY #2099
CH043060 NORTHEAST MISSISSIPPI HEALTH CARE, INC.
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Covered Entity Details
Entity Name
NORTHEAST MISSISSIPPI HEALTH CARE, INC.
Subdivision Name
DBA BYHALIA FAMILY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH043060
Entity Address
12 BRUNSWICK ST
BYHALIA, MS 38611-0012
Grant Number
H80CS00432
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
FRED'S PHARMACY #2099
Pharmacy Address
15 EAST STONEWALL RD
BYHALIA, MS 38611
Pharmacy Comments
11/30/2011 updated address (was 2438 Church Street P.O. Box 407)
Contract Details
Approval Date
9/20/2011
Contract Begin Date
9/20/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/13/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
MARJORIE MCKINNEY, EXECUTIVE DIRECTOR
(662) 838-2163 Ext: 214
Contract Pharmacy Representative
Eddie McCullough, Pharmacist
(662) 838-2521
Signed By Date
9/11/2011
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