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WAL-MART PHARMACY 10-0981
CAH251335-00 Kemper CAH, Inc d/b/a John C. Stennis Memorial Hospital
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Covered Entity Details
Entity Name
Kemper CAH, Inc d/b/a John C. Stennis Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251335-00
Entity Address
14365 Hwy 16 West
DeKalb, MS 39328
Medicare Provider Number
251335
Participating Start Date
10/1/2012
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0981
Pharmacy Address
1733 SECOND ST SOUTH
MERIDIAN, MS 39301
Pharmacy Comments
Contract Details
Approval Date
7/14/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/16/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Nester, ADMINISTRATOR
(601) 776-6925 Ext: 2180
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/14/2014
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