Contract Pharmacy Details

WALGREEN CO.
DSH420091 MUSC Health Florence Medical Center

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 #09761
502 GAPWAY
MULLINS, SC 29574-3414

Pharmacy Comments

Contract Details

Approval Date

1/15/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/11/2020
Pharmacy closed

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

340B Drug Pricing Program Database