Contract Pharmacy Details

WALGREEN CO.
RRC360065-00 FISHER-TITUS MEDICAL CENTER

Covered Entity Details

Entity Name

FISHER-TITUS MEDICAL CENTER

Subdivision Name

Type

Rural Referral Center

340B ID

RRC360065-00

Entity Address

272 BENEDICT AVE
NORWALK, OH 44857

Medicare Provider Number

360065

Participating Start Date

1/1/2017

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #10956
4 E. LEAGUE ST.
NORWALK, OH 44857-1308

Pharmacy Comments

Contract Details

Approval Date

10/9/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Brent W Burkey, MD, President
(440) 660-2550

Contract Pharmacy Representative

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

Signed By Date

10/9/2020

340B Drug Pricing Program Database