Contract Pharmacy Details

WALGREEN CO.
DSH250078 FORREST GENERAL HOSPITAL

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

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 10430
103 WEST CENTRAL AVE
PETAL, MS 39465-2313

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

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

Signed By Date

10/13/2022

340B Drug Pricing Program Database