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WALGREEN CO.
CAH251335-00 Kemper CAH, Inc d/b/a John C. Stennis Memorial Hospital
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Covered Entity Details
Entity Name
Kemper CAH, Inc d/b/a John C. Stennis Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251335-00
Entity Address
14365 Hwy 16 West
DeKalb, MS 39328
Medicare Provider Number
251335
Participating Start Date
10/1/2012
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 10067
1005 W BEACON ST
PHILADELPHIA, MS 39350-3203
Pharmacy Comments
Contract Details
Approval Date
1/8/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Justin Palmer, Administrator
(769) 486-1038
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/8/2019
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