Contract Pharmacy Details

WALGREEN CO.
DSH250001 University of Mississippi Medical Center

Covered Entity Details

Entity Name

University of Mississippi Medical Center

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH250001

Entity Address

2500 NORTH STATE ST.
JACKSON, MS 39216

Medicare Provider Number

250001

Participating Start Date

4/1/1998

Last Recertification Date

8/30/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05791
1497 CANTON MART RD
JACKSON, MS 39211

Pharmacy Comments

Contract Details

Approval Date

7/24/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/5/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

William Thompson, CFO
(601) 984-4113

Contract Pharmacy Representative

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

Signed By Date

7/24/2014

340B Drug Pricing Program Database