Contract Pharmacy Details

CLAYTON PHARMACY
CAH251325-00 COVINGTON COUNTY HOSPITAL

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

CLAYTON PHARMACY

Pharmacy Address

301 HOSPITAL BOULEVARD
COLLINS, MS 39428

Pharmacy Comments

Contract Details

Approval Date

10/11/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/1/2020
Pharmacy closed

Contacts

Covered Entity Signing Official

KIRSTIE EVANS, CFO
(601) 765-6711

Contract Pharmacy Representative

Becky Arnold, Owner
(601) 765-4323

Signed By Date

10/11/2013