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WALGREEN CO.
CAH451379-00 CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
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Covered Entity Details
Entity Name
CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451379-00
Entity Address
1507 W MAIN ST
GATESVILLE, TX 76528-1024
Medicare Provider Number
451379
Participating Start Date
9/29/2010
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09648
9101 WOODWAY DRIVE
WOODWAY, TX 76712
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DAVID BYROM, CEO
(254) 865-8251 Ext: 6300
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2018
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