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WALGREEN CO.
DSH340053 Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center
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Covered Entity Details
Entity Name
Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340053
Entity Address
200 HAWTHORNE LANE
CHARLOTTE, NC 28204
Medicare Provider Number
340053
Participating Start Date
4/1/2008
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07401
13720 HIGHWAY 74
INDIAN TRAIL, NC 28079-7600
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cedric A Terrell, SVP Pharmacy Services
(704) 384-0611
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/11/2019
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