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WALGREEN CO.
DSH250040 SINGING RIVER HEALTH SYSTEM
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Covered Entity Details
Entity Name
SINGING RIVER HEALTH SYSTEM
Subdivision Name
SINGING RIVER HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH250040
Entity Address
2809 DENNY AVENUE
PASCAGOULA, MS 39581
Medicare Provider Number
250040
Participating Start Date
3/15/2022
Last Recertification Date
9/8/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17035
4031 POPPS FERRY RD STE A
DIBERVILLE, MS 39540
Pharmacy Comments
Contract Details
Approval Date
7/3/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/12/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Heath Allen Thompson, Administrator Ancillary Services
(228) 818-1191
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/3/2018
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