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WALGREEN CO
DSH250034 BAPTIST MEMORIAL HOSPITAL - NORTH MISSISSIPPI
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Covered Entity Details
Entity Name
BAPTIST MEMORIAL HOSPITAL - NORTH MISSISSIPPI
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250034
Entity Address
1100 Belk Blvd
OXFORD, MS 38655-5373
Medicare Provider Number
250034
Participating Start Date
7/1/2018
Last Recertification Date
9/8/2020
Entity Termination Date
6/4/2021
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #12436
225 HWY 30 W
NEW ALBANY, MS 38652-3129
Pharmacy Comments
Contract Details
Approval Date
10/5/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/4/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
David Barham, VP, Operations Finance CFO
(901) 227-7467
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/5/2018
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