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FRED'S PHARMACY #7141
CAH251304-00 TALLAHATCHIE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
TALLAHATCHIE GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251304-00
Entity Address
141 Dr. T.T. Lewis Circle
CHARLESTON, MS 38921
Medicare Provider Number
251304
Participating Start Date
4/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
FRED'S PHARMACY #7141
Pharmacy Address
304 MAIN STREET
CHARLESTON, MS 38921
Pharmacy Comments
Contract Details
Approval Date
10/12/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
James D. Blackwood, CEO
(662) 625-5535
Contract Pharmacy Representative
Fred's Pharmacy
Betty Ngo, Sr. Director 340B Program Operations
(901) 481-0346
Signed By Date
10/12/2016
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