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WALGREEN CO.
DSH100088 BAPTIST MEDICAL CENTER
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Covered Entity Details
Entity Name
BAPTIST MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100088
Entity Address
800 PRUDENTIAL DRIVE
JACKSONVILLE, FL 32207
Medicare Provider Number
100088
Participating Start Date
7/1/2006
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04638
654 CASSAT AVE
JACKSONVILLE, FL 32205
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
4/21/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott M. Wooten, SVP & CFO
(904) 202-3405
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2020
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