Contract Pharmacy Details

WALGREEN CO.
DSH340010 WAYNE MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

WAYNE MEMORIAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH340010

Entity Address

2700 WAYNE MEMORIAL DRIVE
GOLDSBORO, NC 27534

Medicare Provider Number

340010

Participating Start Date

7/1/2004

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #13854
1103 N. BREAZEALE AVE.
MOUNT OLIVE, NC 28365

Pharmacy Comments

Contract Details

Approval Date

4/14/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

William Thoma, Senior VP, Finance; CFO
(919) 731-6143

Contract Pharmacy Representative

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

Signed By Date

4/14/2020

340B Drug Pricing Program Database