Contract Pharmacy Details

MISSISSIPPI CVS PHARMACY, L.L.C.
DSH250004 NORTH MISSISSIPPI MEDICAL CENTER

Covered Entity Details

Entity Name

NORTH MISSISSIPPI MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH250004

Entity Address

830 SOUTH GLOSTER ST
TUPELO, MS 38801

Medicare Provider Number

250004

Participating Start Date

1/1/2005

Last Recertification Date

9/6/2024

Pharmacy Details

Pharmacy Name

MISSISSIPPI CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04536
301 AMERICAN AVENUE
BOONEVILLE, MS 38829

Pharmacy Comments

Contract Details

Approval Date

7/15/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

BRUCE J. TOPPIN, GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY
(662) 377-4229

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/15/2021

340B Drug Pricing Program Database