Contract Pharmacy Details

WALGREEN CO.
DSH180149 TJ HEALTH COLUMBIA

Covered Entity Details

Entity Name

TJ HEALTH COLUMBIA

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180149

Entity Address

901 Wellness Way
COLUMBIA, KY 42728

Medicare Provider Number

180149

Participating Start Date

4/1/2019

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #17581
411 W STOCKTON ST
EDMONTON, KY 42129

Pharmacy Comments

Contract Details

Approval Date

4/12/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Neil Thornbury, CEO
(270) 651-4159

Contract Pharmacy Representative

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

Signed By Date

4/12/2019

340B Drug Pricing Program Database