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TYSON DRUGS INC
CH04306D NORTHEAST MISSISSIPPI HEALTH CARE, INC.
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Covered Entity Details
Entity Name
NORTHEAST MISSISSIPPI HEALTH CARE, INC.
Subdivision Name
DeSoto Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH04306D
Entity Address
7535 Airways Boulevard
Southaven, MS 38671-5816
Grant Number
H80CS00432
Participating Start Date
10/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
TYSON DRUGS INC
Pharmacy Address
145 E VAN DORN AVE
P.O. BOX 10
HOLLY SPRINGS, MS 38635-3025
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clifton Rodgers, Physician
(662) 349-6220
Contract Pharmacy Representative
TYSON DRUGS
CHELSEA ANDERSON, MANAGER
(662) 252-2321
Signed By Date
4/16/2018
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