340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
MISSISSIPPI CVS PHARMACY, L.L.C.
DSH040072 BAPTIST HEALTH MEDICAL CENTER - STUTTGART
Print
Covered Entity Details
Entity Name
BAPTIST HEALTH MEDICAL CENTER - STUTTGART
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040072
Entity Address
1703 NORTH BUERKLE
STUTTGART, AR 72160
Medicare Provider Number
040072
Participating Start Date
1/1/2011
Last Recertification Date
9/18/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
MISSISSIPPI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08955
55 GOODMAN ROAD WEST
SOUTHAVEN, MS 38671
Pharmacy Comments
Contract Details
Approval Date
10/16/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/16/2020
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session