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BRANDON DISCOUNT DRUGS
CAH251317-00 SIMPSON GENERAL HOSPITAL
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Covered Entity Details
Entity Name
SIMPSON GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251317-00
Entity Address
1842 SIMPSON HWY 149
MENDENHALL, MS 39114
Medicare Provider Number
251317
Participating Start Date
10/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
BRANDON DISCOUNT DRUGS
Pharmacy Address
ATTN: RYAN C. HARPER
200 TAMBERLINE ST
BRANDON, MS 39042
Pharmacy Comments
Contract Details
Approval Date
7/6/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
AL GARY, COO
(601) 847-7151
Contract Pharmacy Representative
Ryan Harper, Owner/Pharmacist
(601) 825-2897
Signed By Date
7/6/2016
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