Contract Pharmacy Details

WALGREEN CO.
DSH250001 University of Mississippi Medical Center

Covered Entity Details

Entity Name

University of Mississippi Medical Center

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH250001

Entity Address

2500 NORTH STATE ST.
JACKSON, MS 39216

Medicare Provider Number

250001

Participating Start Date

4/1/1998

Last Recertification Date

8/30/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #15317
1424 UNION AVE
MEMPHIS, TN 38104

Pharmacy Comments

Formally Bioscript Pharmacy

Contract Details

Approval Date

7/14/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jeffrey Grimsley, CFO-Health System
(601) 815-6270

Contract Pharmacy Representative

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

Signed By Date

7/14/2022

340B Drug Pricing Program Database