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MOORE'S PHARMACY
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
MOORE'S PHARMACY
Pharmacy Address
16831 HWY 21 SOUTH
P.O. BOX 289
SEBASTOPOL, MS 39359
Pharmacy Comments
Contract Details
Approval Date
7/15/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/11/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Daryl W. Weaver, CEO
(601) 267-1422
Contract Pharmacy Representative
Rodney Moore, Owner
(601) 267-8078
Signed By Date
7/15/2014
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