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WALGREEN CO.
DSH340069 WAKEMED
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Covered Entity Details
Entity Name
WAKEMED
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340069
Entity Address
3000 NEW BERN AVENUE
RALEIGH, NC 27610
Medicare Provider Number
340069
Participating Start Date
1/1/2016
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS #15552
1116 US HWY 70 WEST
GARNER, NC 27529
Pharmacy Comments
Contract Details
Approval Date
4/16/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DONALD GINTZIG, President and CEO
(919) 350-8102
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2019
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