Contract Pharmacy Details

WALGREEN CO.
CH040780 DELTA HEALTH CENTER, INC.

Covered Entity Details

Entity Name

DELTA HEALTH CENTER, INC.

Subdivision Name

DELTA HEALTH CENTER, INC.

Type

HRSA-Funded Health Center

340B ID

CH040780

Entity Address

702 MARTIN L. KING ROAD
MOUND BAYOU, MS 38762-0900

Grant Number

H80CS00085

Participating Start Date

12/1/1992

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 09896
301 N DAVIS AVE
CLEVELAND, MS 38732-2349

Pharmacy Comments

Contract Details

Approval Date

1/19/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/6/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

John A. Fairman, CEO
(662) 741-8880

Contract Pharmacy Representative

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

Signed By Date

1/19/2016

340B Drug Pricing Program Database