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DIXON'S DISCOUNT PHARMACY
CAH251309-00 FIELD MEMORIAL COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
FIELD MEMORIAL COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251309-00
Entity Address
178 HWY 24
CENTREVILLE, MS 39631-4171
Medicare Provider Number
251309
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
DIXON'S DISCOUNT PHARMACY
Pharmacy Address
434-B SOUTH CAPTAIN GLOSTER DRIVE
PO BOX 370
GLOSTER, MS 39638
Pharmacy Comments
Contract Details
Approval Date
10/15/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CHAD NETTERVILLE, CEO
(601) 645-5221
Contract Pharmacy Representative
Heather M. Priest, Pharmacist In Charge
(601) 225-7907
Signed By Date
10/15/2014
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