Contract Pharmacy Details

WALGREEN CO.
DSH010091 GROVE HILL MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

GROVE HILL MEMORIAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH010091

Entity Address

295 SOUTH JACKSON STREET
GROVE HILL, AL 36451

Medicare Provider Number

010091

Participating Start Date

1/1/2020

Last Recertification Date

8/27/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #11115
33495 HIGHWAY 43
THOMASVILLE, AL 36784-3425

Pharmacy Comments

Contract Details

Approval Date

4/8/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Kenneth Larrimore, COO
(251) 275-3191

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/8/2020

340B Drug Pricing Program Database