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MISSISSIPPI CVS PHARMACY, L.L.C.
DSH250078 FORREST GENERAL HOSPITAL
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Covered Entity Details
Entity Name
FORREST GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250078
Entity Address
6051 U.S. HIGHWAY 49
HATTIESBURG, MS 39401
Medicare Provider Number
250078
Participating Start Date
7/1/2002
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
MISSISSIPPI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05740
1701 A HWY 43 N
PICAYUNE, MS 39466
Pharmacy Comments
Contract Details
Approval Date
10/13/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ben Hester, CFO
(601) 288-4225
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/13/2022
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