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WALGREEN CO.
CAH141300-00 THOMAS H BOYD CRITICAL ACC HOSPITAL
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Covered Entity Details
Entity Name
THOMAS H BOYD CRITICAL ACC HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141300-00
Entity Address
800 SCHOOL STREET
CARROLLTON, IL 62016
Medicare Provider Number
141300
Participating Start Date
10/1/2018
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS SPECIALTY PHARMACY #21190
1150 N 5TH ST
STE B
SPRINGFIELD, IL 62702
Pharmacy Comments
Contract Details
Approval Date
4/8/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Deborah J Campbell, CEO
(217) 942-6946
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/8/2019
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