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MISSISSIPPI CVS PHARMACY, L.L.C.
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
MISSISSIPPI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 6031
1912 JACKSON AVE. W
OXFORD, MS 38655
Pharmacy Comments
Contract Details
Approval Date
1/20/2022
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
1/20/2022
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