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WALGREEN CO.
RRC250141-00 BAPTIST MEM HOSPITAL DESOTO
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Covered Entity Details
Entity Name
BAPTIST MEM HOSPITAL DESOTO
Subdivision Name
Type
Rural Referral Center
340B ID
RRC250141-00
Entity Address
7601 SOUTHCREST
SOUTHAVEN, MS 38671
Medicare Provider Number
250141
Participating Start Date
11/12/2020
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04600
3445 ELVIS PRESLEY BLVD.
MEMPHIS, TN 38116
Pharmacy Comments
Contract Details
Approval Date
11/12/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/21/2025
Pharmacy closed
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
10/13/2020
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