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WALGREEN CO
DSH110150 Atrium Health Navicent Baldwin
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Covered Entity Details
Entity Name
Atrium Health Navicent Baldwin
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110150
Entity Address
821 N. COBB STREET
MILLEDGEVILLE, GA 31061
Medicare Provider Number
110150
Participating Start Date
1/1/2019
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10832
2350 N COLUMBIA ST
MILLEDGEVILLE, GA 31061-2091
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/12/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Todd Dixon, CEO
(478) 454-3550
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2018
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