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WALGREEN CO.
DSH450848 Memorial Hermann Sugar Land Hospital
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Covered Entity Details
Entity Name
Memorial Hermann Sugar Land Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450848
Entity Address
17500 West Grand Parkway
Sugar Land, TX 77479
Medicare Provider Number
450848
Participating Start Date
1/1/2012
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03696
4711 SWEETWATER BLVD.
SUGAR LAND, TX 77479
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rebecca Tucker, VP, Finance
(713) 456-5340
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2019
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