Contract Pharmacy Details

KROGER PHARMACY #466
CH04075B CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.

Covered Entity Details

Entity Name

CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.

Subdivision Name

Jackson-Hinds Utica Clinic

Type

HRSA-Funded Health Center

340B ID

CH04075B

Entity Address

129 White Oak St
Utica, MS 39175

Grant Number

H80CS00084

Participating Start Date

7/1/2010

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

KROGER PHARMACY #466

Pharmacy Address

3408 PEMBERTON SQUARE BLVD
VICKSBURG, MS 39180-5573

Pharmacy Comments

Contract Details

Approval Date

4/5/2011

Contract Begin Date

4/7/2011

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Signed By Date

340B Drug Pricing Program Database