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WINN-DIXIE PHARMACY #533
DSH250069 RUSH FOUNDATION HOSPITAL
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Covered Entity Details
Entity Name
RUSH FOUNDATION HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250069
Entity Address
1314 19TH AVENUE
MERIDIAN, MS 39301
Medicare Provider Number
250069
Participating Start Date
4/1/2008
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WINN-DIXIE PHARMACY #533
Pharmacy Address
5100 HIGHWAY 39 N.
MERIDIAN, MS 39301
Pharmacy Comments
Contract Details
Approval Date
1/13/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/12/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Chuck Reece, COO
(601) 483-0011
Contract Pharmacy Representative
Curtis Hartin, Director of Pharmacy Managed Care
(904) 370-7776
Signed By Date
1/13/2014
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