Contract Pharmacy Details

WALGREEN CO.
CH043060 NORTHEAST MISSISSIPPI HEALTH CARE, INC.

Covered Entity Details

Entity Name

NORTHEAST MISSISSIPPI HEALTH CARE, INC.

Subdivision Name

DBA BYHALIA FAMILY HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH043060

Entity Address

12 BRUNSWICK ST
BYHALIA, MS 38611-0012

Grant Number

H80CS00432

Participating Start Date

12/1/1992

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 04455
35 STATELINE RD WEST
SOUTHAVEN, MS 38671

Pharmacy Comments

Contract Details

Approval Date

10/4/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Clifton Rodgers, Physician
(662) 349-6220

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/4/2021

340B Drug Pricing Program Database