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WAL-MART PHARMACY 10-0305
CAH251315-00 Baptist Medical Center - Leake, Inc.
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Covered Entity Details
Entity Name
Baptist Medical Center - Leake, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251315-00
Entity Address
1100 Hwy 16 East
CARTHAGE, MS 39051
Medicare Provider Number
251315
Participating Start Date
1/1/2014
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0305
Pharmacy Address
905 HIGHWAY 16 WEST
CARTHAGE, MS 39051
Pharmacy Comments
Contract Details
Approval Date
1/2/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daryl W. Weaver, CEO
(601) 267-1422
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/2/2014
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