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WALGREEN CO.
DSH250100 BAPTIST MEMORIAL HOSPITAL-GOLDEN TRIANGLE
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Covered Entity Details
Entity Name
BAPTIST MEMORIAL HOSPITAL-GOLDEN TRIANGLE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250100
Entity Address
2520 5TH STREET N
COLUMBUS, MS 39705-2008
Medicare Provider Number
250100
Participating Start Date
9/2/2008
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #19986
201B ALABAMA ST
COLUMBUS, MS 39702
Pharmacy Comments
Contract Details
Approval Date
1/22/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Barham, VP, Operations Finance CFO
(901) 227-7467
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/22/2019
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