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ACKERMAN DISCOUNT DRUGS
CAH251334-00 CHOCTAW REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CHOCTAW REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251334-00
Entity Address
8613 MS HWY 12
ACKERMAN, MS 39735
Medicare Provider Number
251334
Participating Start Date
7/1/2015
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
ACKERMAN DISCOUNT DRUGS
Pharmacy Address
DISCOUNT DRUGS OF MS, INC
518 CHESTER ST
SUITE 2
ACKERMAN, MS 39735-9517
Pharmacy Comments
Contract Details
Approval Date
7/6/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jamie Rodgers, CEO
(662) 285-4400
Contract Pharmacy Representative
Laura Daniel, Member
(662) 285-9333
Signed By Date
7/6/2015
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