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WESTGATE DRUGS INC
DSH250042 Northwest Miss Regional Medical Center DBA Northwest Mississippi Regional Medical Center
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Covered Entity Details
Entity Name
Northwest Miss Regional Medical Center DBA Northwest Mississippi Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250042
Entity Address
1970 HOSPITAL DRIVE
CLARKSDALE, MS 38614
Medicare Provider Number
250042
Participating Start Date
6/16/2021
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WESTGATE DRUGS INC
Pharmacy Address
WESTGATE SHOPPING CENTER
1015 LEE DR
P.O. BOX 308
CLARKSDALE, MS 38614
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lorie Suzanne Till, CEO
(662) 624-3463
Contract Pharmacy Representative
Westgate Drugs
Eddie Ellis, Owner
(662) 902-1780
Signed By Date
7/15/2024
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