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CAREMARK, L.L.C.
DSH250097 SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250097
Entity Address
215 MARION AVE.
MCCOMB, MS 39648-2705
Medicare Provider Number
250097
Participating Start Date
9/9/2005
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
CAREMARK, L.L.C.
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
7251 S. EASTERN AVE.
LAS VEGAS, NV 89119
Pharmacy Comments
Contract Details
Approval Date
10/13/2022
Contract Begin Date
11/15/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Cornelius Weathersby, Chief Operating Officer
(601) 249-1882
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/13/2022
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