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FRED'S PHARMACY #1061
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
FRED'S PHARMACY #1061
Pharmacy Address
PO BOX 880
222 MABUS STREET
ACKERMAN, MS 39735
Pharmacy Comments
Contract Details
Approval Date
7/14/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/26/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Jamie Rodgers, CEO
(662) 285-4400
Contract Pharmacy Representative
Shannon Strickland, SVP, Pharmacy Development
(901) 238-3113
Signed By Date
7/14/2015
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