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AHSSHC
CAH250010-00 TIPPAH COUNTY HOSPITAL
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Covered Entity Details
Entity Name
TIPPAH COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH250010-00
Entity Address
1005 CITY AVE N
RIPLEY, MS 38663
Medicare Provider Number
250010
Participating Start Date
10/1/2015
Last Recertification Date
8/21/2018
Entity Termination Date
10/1/2019
Pharmacy Details
Pharmacy Name
AHSSHC
Pharmacy Address
EXPEDIEN RX PHARMACY
5050 WESLEY RD STE 120
APOPKA, FL 32712
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Patrick Chapman, CEO
(662) 837-9221
Contract Pharmacy Representative
Agape
Trenia Yielding, Executive Director
(407) 357-2601
Signed By Date
7/17/2017
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