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MISSISSIPPI CVS PHARMACY, L.L.C.
DSH440152 Regional One Health
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Covered Entity Details
Entity Name
Regional One Health
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440152
Entity Address
877 JEFFERSON AVENUE
MEMPHIS, TN 38103
Medicare Provider Number
440152
Participating Start Date
4/1/1993
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
MISSISSIPPI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05604
5025 HWY 305
OLIVE BRANCH, MS 38654
Pharmacy Comments
Contract Details
Approval Date
1/17/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rick Wagers, CFO
(901) 545-7676
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/17/2021
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