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WALGREENS SPECIALTY PHARMACY, LLC
CAH251323-00 SCOTT REGIONAL HOSPITAL
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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
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
1/3/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2019
Business decision by covered entity and/or pharmacy
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
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