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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
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15317
1424 UNION AVE
MEMPHIS, TN 38104
Pharmacy Comments
Formally Bioscript Pharmacy
Contract Details
Approval Date
10/20/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
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
10/20/2020
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