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WALGREEN CO.
DSH250099 GREENWOOD LEFLORE HOSPITAL
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Covered Entity Details
Entity Name
GREENWOOD LEFLORE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250099
Entity Address
1401 RIVER ROAD
GREENWOOD, MS 38930
Medicare Provider Number
250099
Participating Start Date
10/1/2001
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12269
329 SUNSET DRIVE
GRENADA, MS 38901-4505
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dawne Holmes, CFO
(662) 459-7119
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2020
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