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FRED'S PHARMACY
CAH251322-00 LAIRD HOSPITAL, INC.
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Covered Entity Details
Entity Name
LAIRD HOSPITAL, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251322-00
Entity Address
25117 HWY 15 BYPASS
UNION, MS 39365
Medicare Provider Number
251322
Participating Start Date
1/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
FRED'S PHARMACY
Pharmacy Address
714 PECAN AVENUNE
PHILADELPHIA, MS 39350
Pharmacy Comments
Contract Details
Approval Date
4/9/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/14/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
THOMAS BARTLETT, HOSPITAL ADMINISTRATOR
(601) 774-8214 Ext: 1500
Contract Pharmacy Representative
Shannon Strickland, SVP, Pharmacy Development
(901) 238-3113
Signed By Date
4/9/2015
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