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WALGREEN CO.
CAH251315-00 Baptist Medical Center - Leake, Inc.
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Covered Entity Details
Entity Name
Baptist Medical Center - Leake, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251315-00
Entity Address
1100 Hwy 16 East
CARTHAGE, MS 39051
Medicare Provider Number
251315
Participating Start Date
1/1/2014
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
CARTHAGE DISCOUNT DRUG #15737, POWERED B
602 HWY 16 EAST
CARTHAGE, MS 39051
Pharmacy Comments
Contract Details
Approval Date
4/17/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/5/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
David Barham, VP, Operations Finance CFO
(901) 227-7467
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/17/2019
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