Contract Pharmacy Details

MISSISSIPPI CVS PHARMACY, L.L.C.
CAH251335-00 Kemper CAH, Inc d/b/a John C. Stennis Memorial Hospital

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

MISSISSIPPI CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05835
2401 NORTH HILLS STREET
MERIDIAN, MS 39305

Pharmacy Comments

Contract Details

Approval Date

7/10/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/14/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Michael Nester, ADMINISTRATOR
(601) 776-6925 Ext: 2180

Contract Pharmacy Representative

CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241

Signed By Date

7/10/2014

340B Drug Pricing Program Database