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WALGREEN CO.
CH046080 CENTRAL MISSISSIPPI HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
CENTRAL MISSISSIPPI HEALTH SERVICES, INC.
Subdivision Name
CENTRAL MISSISSIPPI HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH046080
Entity Address
1134 Winter St
Jackson, MS 39204-2841
Grant Number
H80CS00860
Participating Start Date
7/1/1996
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #21165
971 LAKELAND DRIVE
SUITE 101
JACKSON, MS 39216
Pharmacy Comments
Contract Details
Approval Date
4/9/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Smith, MD
(601) 948-5572
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/9/2019
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