Contract Pharmacy Details

WALGREEN CO.
CH045800 GOSHEN MEDICAL CENTER, INC.

Covered Entity Details

Entity Name

GOSHEN MEDICAL CENTER, INC.

Subdivision Name

GOSHEN MEDICAL CENTER, INC.

Type

HRSA-Funded Health Center

340B ID

CH045800

Entity Address

444 SW Center St
Faison, NC 28341

Grant Number

H80CS00181

Participating Start Date

7/1/2003

Last Recertification Date

3/10/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #01051
4577 MAIN ST.
SHALLOTTE, NC 28470

Pharmacy Comments

Contract Details

Approval Date

4/12/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/24/2024
Agreement registered in error

Contacts

Covered Entity Signing Official

GREG BOUNDS, CEO
(910) 267-1942 Ext: 1117

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