Contract Pharmacy Details

WALNUT GROVE PLAZA PHARMACY #2
DSH250141 BAPTIST MEMORIAL HOSPITAL- DESOTO

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

WALNUT GROVE PLAZA PHARMACY #2

Pharmacy Address

6027 WALNUT GROVE RD
STE 110
MEMPHIS, TN 38120-2115

Pharmacy Comments

Contract Details

Approval Date

2/17/2017

Contract Begin Date

4/1/2017

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

Baptist Memorial Health Care Corp
Donna C Cox, Director 340B
(901) 227-5144

Signed By Date

2/17/2017

340B Drug Pricing Program Database