Contract Pharmacy Details

WALGREEN CO.
CAH251323-00 SCOTT REGIONAL HOSPITAL

Covered Entity Details

Entity Name

SCOTT REGIONAL HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH251323-00

Entity Address

317 HIGHWAY 13 SOUTH
MORTON, MS 39117

Medicare Provider Number

251323

Participating Start Date

1/1/2011

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #12536
219 WOODLAND DRIVE NORTH
FOREST, MS 39074

Pharmacy Comments

Contract Details

Approval Date

1/3/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Suzanne Mize, 340B Administrator
(205) 459-9180

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/3/2019

340B Drug Pricing Program Database