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WAL-MART PHARMACY 10-2715
CAH251329-00 GREENE COUNTY HOSPITAL
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Covered Entity Details
Entity Name
GREENE COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251329-00
Entity Address
1017 JACKSON AVENUE
LEAKESVILLE, MS 39451-9105
Medicare Provider Number
251329
Participating Start Date
4/1/2011
Last Recertification Date
8/25/2023
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2715
Pharmacy Address
3615 SANGANI BLVD.
D'IBERVILLE, MS 39540
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
GREG HAVARD, CHIEF EXECUTIVE OFFICER
(601) 947-9148
Contract Pharmacy Representative
walmart
kathi julie howard phelps, manager contracting 340b
(479) 277-3719
Signed By Date
4/15/2019
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