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WAL-MART PHARMACY 10-0239
CAH251336-00 Baptist Medical Center Attala
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Covered Entity Details
Entity Name
Baptist Medical Center Attala
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251336-00
Entity Address
220 Hwy 12 W
Kosciusko, MS 39090
Medicare Provider Number
251336
Participating Start Date
4/1/2014
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0239
Pharmacy Address
220 VETERANS MEMORIAL DRIVE
KOSCIUSKO, MS 39090
Pharmacy Comments
Contract Details
Approval Date
7/1/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Dawson, CEO
(662) 290-3300
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/1/2014
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