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CRANFORDS DRUG STORE INC
CAH251325-00 COVINGTON COUNTY HOSPITAL
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Covered Entity Details
Entity Name
COVINGTON COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251325-00
Entity Address
701 SOUTH HOLLY STREET
COLLINS, MS 39428
Medicare Provider Number
251325
Participating Start Date
8/18/2010
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
CRANFORDS DRUG STORE INC
Pharmacy Address
CRANFORDS DRUG STORE
P.O. BOX 130
121 W. MAIN ST
SEMINARY, MS 39479
Pharmacy Comments
Contract Details
Approval Date
10/11/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KIRSTIE EVANS, CFO
(601) 765-6711
Contract Pharmacy Representative
Donna Wilcosky, Owner
(601) 722-3291
Signed By Date
10/11/2013
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