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WAL-MART PHARMACY 10-0903
CH046080 CENTRAL MISSISSIPPI HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
CENTRAL MISSISSIPPI HEALTH SERVICES, INC.
Subdivision Name
CENTRAL MISSISSIPPI HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH046080
Entity Address
1134 Winter St
Jackson, MS 39204-2841
Grant Number
H80CS00860
Participating Start Date
7/1/1996
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0903
Pharmacy Address
2711 GREENWAY DRIVE
JACKSON, MS 39204
Pharmacy Comments
Contract Details
Approval Date
1/7/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ROBERT SMITH, CEO
(601) 948-5572
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/7/2015
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