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WALNUT GROVE PLAZA PHARMACY #2
RRC250102-00 MS BAPTIST MEDICAL CENTER
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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
WALNUT GROVE PLAZA PHARMACY #2
Pharmacy Address
6027 WALNUT GROVE RD
STE 110
MEMPHIS, TN 38120-2115
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
12/12/2023
Ownership change
Contacts
Covered Entity Signing Official
Kimberly Young, Vice President-Finance Operations
(901) 227-4080
Contract Pharmacy Representative
Baptist Memorial Health Care Corp
Donna C Cox, Director 340B
(901) 227-5144
Signed By Date
1/3/2023
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