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WALGREEN CO.
DSH250104 ANDERSON REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ANDERSON REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250104
Entity Address
2124 14th Street
MERIDIAN, MS 39301
Medicare Provider Number
250104
Participating Start Date
4/1/2009
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07580
1415 24TH AVE
MERIDIAN, MS 39301-3930
Pharmacy Comments
Contract Details
Approval Date
7/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John G. Anderson, CEO
(601) 553-6104
Contract Pharmacy Representative
Anderson Regional Medical Center
HOLLY MOORE, DIRECTOR OF INPATIENT PHARMACY
(601) 553-6606
Signed By Date
7/12/2024
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