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Walmart Pharmacy 10-7611
CAH251327-00 Copiah County Medical Center
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Covered Entity Details
Entity Name
Copiah County Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251327-00
Entity Address
27190 Highway 28
HAZLEHURST, MS 39083
Medicare Provider Number
251327
Participating Start Date
7/1/2019
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
William T. Morgan, Chief Executive Officer
(601) 574-7200
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/16/2023
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