Contract Pharmacy Details

MISSISSIPPI CVS PHARMACY, L.L.C.
CAH251315-00 Baptist Medical Center - Leake, Inc.

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

MISSISSIPPI CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04519
205 HIGHWAY 16 WEST
CARTHAGE, MS 39051

Pharmacy Comments

Contract Details

Approval Date

10/18/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/30/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Daryl W. Weaver, CEO
(601) 267-1422

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/18/2016

340B Drug Pricing Program Database