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WALGREEN CO.
DSH250034 BAPTIST MEMORIAL HOSPITAL - NORTH MISSISSIPPI
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Covered Entity Details
Entity Name
BAPTIST MEMORIAL HOSPITAL - NORTH MISSISSIPPI
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250034
Entity Address
1100 Belk Blvd
OXFORD, MS 38655-5373
Medicare Provider Number
250034
Participating Start Date
7/1/2018
Last Recertification Date
9/8/2020
Entity Termination Date
6/4/2021
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06771
817 W MAIN STREET
TUPELO, MS 38801
Pharmacy Comments
Contract Details
Approval Date
4/15/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Dana Williams, CFO
(662) 232-8102
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2013
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