Contract Pharmacy Details

WALGREEN CO.
RRC250102-00 MS BAPTIST MEDICAL CENTER

Covered Entity Details

Entity Name

MS BAPTIST MEDICAL CENTER

Subdivision Name

Type

Rural Referral Center

340B ID

RRC250102-00

Entity Address

1225 NORTH STATE ST.
JACKSON, MS 39202

Medicare Provider Number

250102

Participating Start Date

11/28/2022

Last Recertification Date

8/27/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 07184
2896 MCDOWELL ROAD EXTENSION
JACKSON, MS 39204-4238

Pharmacy Comments

Contract Details

Approval Date

1/3/2023

Contract Begin Date

4/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/17/2025
Pharmacy closed

Contacts

Covered Entity Signing Official

Kimberly Young, Vice President-Finance Operations
(901) 227-4080

Contract Pharmacy Representative

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

Signed By Date

1/3/2023

340B Drug Pricing Program Database