Contract Pharmacy Details

BOONE'S PHARMACY
CAH251333-00 PEARL RIVER COUNTY HOSPITAL

Covered Entity Details

Entity Name

PEARL RIVER COUNTY HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH251333-00

Entity Address

305 W. MOODY STREET
POPLARVILLE, MS 39470

Medicare Provider Number

251333

Participating Start Date

4/1/2011

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

BOONE'S PHARMACY

Pharmacy Address

937 S MAIN ST
POPLARVILLE, MS 39470-3111

Pharmacy Comments

Contract Details

Approval Date

10/20/2011

Contract Begin Date

10/21/2011

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/4/2017
Agreement registered in error

Contacts

Covered Entity Signing Official

Mike Boleware, CEO
(601) 795-4543

Contract Pharmacy Representative

Larry Boone, Owner
(601) 795-4566

Signed By Date

10/14/2011