Contract Pharmacy Details

WALGREEN CO.
RRC340014-00 FORSYTH MEMORIAL HOSPITAL INC

Covered Entity Details

Entity Name

FORSYTH MEMORIAL HOSPITAL INC

Subdivision Name

Type

Rural Referral Center

340B ID

RRC340014-00

Entity Address

3333 SILAS CREEK PARKWAY
WINSTON SALEM, NC 27103

Medicare Provider Number

340014

Participating Start Date

7/7/2020

Last Recertification Date

8/23/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #21282
255A CHARLOIS BLVD
WINSTON SALEM, NC 27103

Pharmacy Comments

Contract Details

Approval Date

7/7/2020

Contract Begin Date

7/29/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/20/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

Geoffrey Gardner, SVP Finance
(336) 718-2078

Contract Pharmacy Representative

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

Signed By Date

7/6/2020

340B Drug Pricing Program Database