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WALGREEN CO.
CAH251325-00 COVINGTON COUNTY HOSPITAL
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Covered Entity Details
Entity Name
COVINGTON COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251325-00
Entity Address
701 SOUTH HOLLY STREET
COLLINS, MS 39428
Medicare Provider Number
251325
Participating Start Date
8/18/2010
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09037
419 N 16TH AVE
LAUREL, MS 39440-3850
Pharmacy Comments
Contract Details
Approval Date
10/10/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gregg Gibbes, CEO
(601) 765-6711
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/10/2017
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