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WALGREEN CO.
DSH340127 GRANVILLE MEDICAL CENTER
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Covered Entity Details
Entity Name
GRANVILLE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340127
Entity Address
1010 COLLEGE STREET
OXFORD, NC 27565
Medicare Provider Number
340127
Participating Start Date
7/1/2004
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS #15551
703 NORTH MAIN STREET
CREEDMOOR, NC 27522
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/7/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Adam West McConnell, CEO
(919) 690-3402
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2019
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