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MAGIC MART PHARMACY INC
SCH250095-00 South Sunflower County Hospital
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Covered Entity Details
Entity Name
South Sunflower County Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH250095-00
Entity Address
121 East Baker Street
Indianola, MS 38751-2462
Medicare Provider Number
250095
Participating Start Date
10/1/2013
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
MAGIC MART PHARMACY INC
Pharmacy Address
903 HWY 82 EAST
BUILDING G
INDIANOLA, MS 38751
Pharmacy Comments
Contract Details
Approval Date
1/15/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Courtney Phillips, Administrator/CFO
(662) 635-7200
Contract Pharmacy Representative
Rolling Fork Drug Co
Guy Phillips, President
(662) 887-4135
Signed By Date
1/15/2014
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