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MISSISSIPPI CVS PHARMACY, L.L.C.
CAH251315-00 Baptist Medical Center - Leake, Inc.
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Covered Entity Details
Entity Name
Baptist Medical Center - Leake, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251315-00
Entity Address
1100 Hwy 16 East
CARTHAGE, MS 39051
Medicare Provider Number
251315
Participating Start Date
1/1/2014
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
MISSISSIPPI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04519
205 HIGHWAY 16 WEST
CARTHAGE, MS 39051
Pharmacy Comments
Contract Details
Approval Date
1/13/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kimberly Young, Vice President-Finance Operations
(901) 227-4080
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/13/2022
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