340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-0887
DSH250058 SOUTH CENTRAL REGIONAL MEDICAL CENTER
Print
Covered Entity Details
Entity Name
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250058
Entity Address
1220 JEFFERSON STREET
LAUREL, MS 39440
Medicare Provider Number
250058
Participating Start Date
7/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0887
Pharmacy Address
36 BYRD BLVD
PETAL, MS 39465
Pharmacy Comments
Contract Details
Approval Date
7/14/2021
Contract Begin Date
7/21/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/25/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James T. Canizaro, CFO
(601) 399-6139
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/14/2021
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