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COVENANT PHARMACY LLC
CAH251318-01 NORTH SUNFLOWER MEDICAL CENTER
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Covered Entity Details
Entity Name
NORTH SUNFLOWER MEDICAL CENTER
Subdivision Name
SUNFLOWER RURAL HEALTH CLINIC
Type
Critical Access Hospital
340B ID
CAH251318-01
Entity Address
840 NORTH OAK AVENUE
RULEVILLE, MS 38771
Medicare Provider Number
251318
Outpatient Facility Provider Number
253400
Participating Start Date
9/16/2010
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
COVENANT PHARMACY LLC
Pharmacy Address
371A HIGHLAND COLONY PARKWAY
RIDGELAND, MS 39157
Pharmacy Comments
Contract Details
Approval Date
4/9/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/11/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
BILLY MARLOW, CEO
(662) 721-7370
Contract Pharmacy Representative
Anna Alman, Manager
(601) 326-5760
Signed By Date
4/9/2014
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