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THE PHARMACY AT DESOTO
DSH250141 BAPTIST MEMORIAL HOSPITAL- DESOTO
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Covered Entity Details
Entity Name
BAPTIST MEMORIAL HOSPITAL- DESOTO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250141
Entity Address
7601 SOUTHCREST PARKWAY
SOUTHAVEN, MS 38671-4739
Medicare Provider Number
250141
Participating Start Date
9/5/2008
Last Recertification Date
9/15/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
THE PHARMACY AT DESOTO
Pharmacy Address
7601 SOUTHCREST PKWY
WEST ENTRANCE SUITE 100
SOUTHAVEN, MS 38671-4739
Pharmacy Comments
Contract Details
Approval Date
8/3/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
James Huffman, CEO and Administrator
(662) 772-2118
Contract Pharmacy Representative
Proxsys
Jon Bradley Nelson, VP - Operations
(205) 533-9852
Signed By Date
8/3/2015
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