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GUY'S PHARMACY OF HAZLEHURST
CAH251305-00 LAWRENCE COUNTY HOSPITAL
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Covered Entity Details
Entity Name
LAWRENCE COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251305-00
Entity Address
1065 EAST BROAD ST
MONTICELLO, MS 39654
Medicare Provider Number
251305
Participating Start Date
10/1/2015
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
GUY'S PHARMACY OF HAZLEHURST
Pharmacy Address
212 CALDWELL DR
HAZLEHURST, MS 39083
Pharmacy Comments
Contract Details
Approval Date
10/11/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Phillip Wayne Langston, CEO
(601) 587-1202
Contract Pharmacy Representative
Downhome Pharmacy
James Crane, Owner
(601) 695-0210
Signed By Date
10/11/2024
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