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WALGREENS SPECIALTY PHARMACY, LLC
DSH250034 BAPTIST MEMORIAL HOSPITAL - NORTH MISSISSIPPI
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Covered Entity Details
Entity Name
BAPTIST MEMORIAL HOSPITAL - NORTH MISSISSIPPI
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250034
Entity Address
1100 Belk Blvd
OXFORD, MS 38655-5373
Medicare Provider Number
250034
Participating Start Date
7/1/2018
Last Recertification Date
9/8/2020
Entity Termination Date
6/4/2021
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
4/8/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/4/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kimberly Young, Vice President-Finance Operations
(901) 227-4080
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/8/2020
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