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NOVIXUS PHARMACY SERVICES
CH043920 MANTACHIE RURAL HEALTH CARE INC
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Covered Entity Details
Entity Name
MANTACHIE RURAL HEALTH CARE INC
Subdivision Name
Mantachie Rural Health Care, Inc.
Type
HRSA-Funded Health Center
340B ID
CH043920
Entity Address
5681 Highway 363
Mantachie, MS 38855-7632
Grant Number
H80CS00096
Participating Start Date
10/1/1996
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
NOVIXUS PHARMACY SERVICES
Pharmacy Address
43159 W 9 MILE RD.
NOVI, MI 48375-4117
Pharmacy Comments
Contract Details
Approval Date
1/11/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
MARJORIE MCKINNEY, CEO
(662) 282-4226 Ext: 114
Contract Pharmacy Representative
Novixus Pharmacy Services
Richard Grossman, Vice President of Pharmacy Services
(248) 380-2105
Signed By Date
1/11/2018
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