Contract Pharmacy Details

WALGREEN CO
CAH251316-00 H.C. WATKINS MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

H.C. WATKINS MEMORIAL HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH251316-00

Entity Address

605 S ARCHUSA AVE
QUITMAN, MS 39355-2331

Medicare Provider Number

251316

Participating Start Date

4/1/2011

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA: WALGREENS #12929
804 SPRING STREET
WAYNESBORO, MS 39367

Pharmacy Comments

Contract Details

Approval Date

1/7/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Suzanne Mize, 340B Administrator
(205) 459-9180

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/7/2019

340B Drug Pricing Program Database