Contract Pharmacy Details

WALGREEN CO.
CAH251302-00 BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL

Covered Entity Details

Entity Name

BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH251302-00

Entity Address

400 SOUTH CHESTNUT ST
ABERDEEN, MS 39730

Medicare Provider Number

251302

Participating Start Date

9/24/2010

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #17341
200 HIGHWAY 145 N
ABERDEEN, MS 39730

Pharmacy Comments

Contract Details

Approval Date

7/10/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Chris Chandler, CEO
(662) 369-2455

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/10/2020

340B Drug Pricing Program Database