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MISSISSIPPI CVS PHARMACY, L.L.C.
PED013301-00 USA Health Children's and Women's Hospital
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Covered Entity Details
Entity Name
USA Health Children's and Women's Hospital
Subdivision Name
Type
Children's Hospital
340B ID
PED013301-00
Entity Address
1700 Center Street
Mobile, AL 36604-3301
Medicare Provider Number
013301
Participating Start Date
7/1/2013
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
MISSISSIPPI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01119
7021 HWY 614, PO BOX 789
HURLEY, MS 39555
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Benny J Stover, USA Health, CFO
(251) 445-9164
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2021
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