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SUMMIT EXPRESS 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
SUMMIT EXPRESS PHARMACY
Pharmacy Address
105 S LAUREL ST
SUMMIT, MS 39666-9349
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
Summit Express Pharmacy
Charles Tim Stamps, Partner
(601) 465-0500
Signed By Date
10/15/2020
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