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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
WALGREENS #17350
1703 DELAWARE AVE
MCCOMB, MS 39648
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard Williams, Chief Operating Officer
(601) 249-1882
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2021
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