Contract Pharmacy Details

WALGREENS SPECIALTY PHARMACY, LLC
DSH250034 BAPTIST MEMORIAL HOSPITAL - NORTH MISSISSIPPI

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

WALGREENS SPECIALTY PHARMACY, LLC

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188

Pharmacy Comments

Contract Details

Approval Date

4/16/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/5/2016
Business decision by covered entity and/or pharmacy

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

4/16/2014

340B Drug Pricing Program Database