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WALGREEN CO.
DSH040118 NEA BAPTIST MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
NEA BAPTIST MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040118
Entity Address
4800 EAST JOHNSON AVENUE
JONESBORO, AR 72405
Medicare Provider Number
040118
Participating Start Date
4/28/2020
Last Recertification Date
8/26/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #15852
1328 RED WOLF BLVD
JONESBORO, AR 72401
Pharmacy Comments
Contract Details
Approval Date
4/28/2020
Contract Begin Date
4/28/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kimberly Young, Vice President-Finance Operations
(901) 227-4080
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2020
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