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MISSISSIPPI CVS PHARMACY, L.L.C.
CAH251313-00 Baptist Medical Center Yazoo
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Covered Entity Details
Entity Name
Baptist Medical Center Yazoo
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251313-00
Entity Address
823 Grand Ave
Yazoo City, MS 39194
Medicare Provider Number
251313
Participating Start Date
1/1/2013
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
MISSISSIPPI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 6396
800 EAST 15TH STREET
YAZOO CITY, MS 39194
Pharmacy Comments
Contract Details
Approval Date
1/18/2017
Contract Begin Date
4/1/2017
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
Sean Johnson, CEO
(662) 290-3300
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/18/2017
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