Contract Pharmacy Details

MISSISSIPPI CVS PHARMACY, L.L.C.
DSH250162 OCHSNER MEDICAL CENTER - HANCOCK

Covered Entity Details

Entity Name

OCHSNER MEDICAL CENTER - HANCOCK

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH250162

Entity Address

149 DRINKWATER BLVD
BAY ST. LOUIS, MS 39520

Medicare Provider Number

250162

Participating Start Date

1/1/2015

Last Recertification Date

8/29/2023

Entity Termination Date

4/1/2024

Pharmacy Details

Pharmacy Name

MISSISSIPPI CVS PHARMACY, L.L.C.

Pharmacy Address

DBA CVS/PHARMACY #10755
4422 KALANI DR.
DIAMONDHEAD, MS 39525

Pharmacy Comments

Contract Details

Approval Date

7/15/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Alan E. Hodges, CEO
(228) 467-8744

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/15/2020

340B Drug Pricing Program Database