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WALGREEN CO.
DSH420091 MUSC Health Florence Medical Center
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Covered Entity Details
Entity Name
MUSC Health Florence Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420091
Entity Address
805 PAMPLICO HIGHWAY
FLORENCE, SC 29505
Medicare Provider Number
420091
Participating Start Date
1/1/2020
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 10447
1210 HWY 301 NORTH
DILLON, SC 29536-2455
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa Goodlett, Chief Financial Officer
(843) 792-4775
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2020
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