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WINN-DIXIE PHARMACY #533
CAH251322-00 LAIRD HOSPITAL, INC.
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Covered Entity Details
Entity Name
LAIRD HOSPITAL, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251322-00
Entity Address
25117 HWY 15 BYPASS
UNION, MS 39365
Medicare Provider Number
251322
Participating Start Date
1/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WINN-DIXIE PHARMACY #533
Pharmacy Address
5100 HIGHWAY 39 N.
MERIDIAN, MS 39301
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/12/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Suzanne Mize, 340B Administrator
(205) 459-9180
Contract Pharmacy Representative
Southeastern Grociers
David Chism, Seinior Director
(904) 370-6455 Ext: 9043706455
Signed By Date
4/16/2018
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