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EXPRESS CARE PHARMACY
DSH250097 SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250097
Entity Address
215 MARION AVE.
MCCOMB, MS 39648-2705
Medicare Provider Number
250097
Participating Start Date
9/9/2005
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
EXPRESS CARE PHARMACY
Pharmacy Address
1015 DELAWARE AVE STE A
MCCOMB, MS 39648-3827
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard Williams, Chief Operating Officer
(601) 249-1882
Contract Pharmacy Representative
Express Care Pharmacy
Marty L Bigner, Managing Member
(601) 341-9812
Signed By Date
10/15/2020
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