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WALGREEN CO.
DSH340047 NORTH CAROLINA BAPTIST HOSPITAL
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Covered Entity Details
Entity Name
NORTH CAROLINA BAPTIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340047
Entity Address
MEDICAL CENTER BOULEVARD
WINSTON-SALEM, NC 27157
Medicare Provider Number
340047
Participating Start Date
4/1/1998
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #10674
5322 U.S. HIGHWAY 158
ADVANCE, NC 27006-6907
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Conrad Emmerich, Sr. Vice President,Hospital & Business Services
(336) 716-8941
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2020
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