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WALGREEN CO.
RRC250034-00 BAPTIST MEM HOSPITAL NORTH MISS
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Covered Entity Details
Entity Name
BAPTIST MEM HOSPITAL NORTH MISS
Subdivision Name
Type
Rural Referral Center
340B ID
RRC250034-00
Entity Address
1100 BELK BOULEVARD
OXFORD, MS 38655
Medicare Provider Number
250034
Participating Start Date
6/4/2021
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06771
817 W MAIN STREET
TUPELO, MS 38801
Pharmacy Comments
Contract Details
Approval Date
6/4/2021
Contract Begin Date
6/9/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kimberly Young, Vice President-Finance Operations
(901) 227-4080
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/2/2021
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