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CALEB'S HOMETOWN PHARMACY
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
CALEB'S HOMETOWN PHARMACY
Pharmacy Address
801 MAIN ST
COLLINS, MS 39428
Pharmacy Comments
Contract Details
Approval Date
7/5/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/19/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gregg Gibbes, CEO
(601) 765-6711
Contract Pharmacy Representative
Caleb's Hometown Pharmcay
Caleb Williamson, Point of Contact
(601) 765-5055
Signed By Date
7/5/2017
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