Contract Pharmacy Details

MISSISSIPPI CVS PHARMACY, L.L.C.
CAH251338-00 Sharkey Issaquena Community Hospital

Covered Entity Details

Entity Name

Sharkey Issaquena Community Hospital

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH251338-00

Entity Address

19719 Hwy 61
Rolling Fork, MS 39159

Medicare Provider Number

251338

Participating Start Date

7/1/2020

Last Recertification Date

8/17/2023

Entity Termination Date

10/1/2024

Pharmacy Details

Pharmacy Name

MISSISSIPPI CVS PHARMACY, L.L.C.

Pharmacy Address

DBA CVS/PHARMACY # 6396
800 EAST 15TH STREET
YAZOO CITY, MS 39194

Pharmacy Comments

Contract Details

Approval Date

7/13/2022

Contract Begin Date

7/19/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/30/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Steven Gerald Keever, CEO
(662) 873-4395 Ext: 150

Contract Pharmacy Representative

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

Signed By Date

7/13/2022

340B Drug Pricing Program Database