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WAL-MART PHARMACY 10-2715
SCH250036-00 GEORGE COUNTY HOSPITAL
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Covered Entity Details
Entity Name
GEORGE COUNTY HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH250036-00
Entity Address
859 WINTER STREET
LUCEDALE, MS 39452-6603
Medicare Provider Number
250036
Participating Start Date
4/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2715
Pharmacy Address
3615 SANGANI BLVD.
D'IBERVILLE, MS 39540
Pharmacy Comments
Contract Details
Approval Date
4/10/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christy E Roberts, Compliance
(601) 766-6394
Contract Pharmacy Representative
walmart
kathi julie howard phelps, manager contracting 340b
(479) 277-3719
Signed By Date
4/10/2019
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