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WALGREEN CO
DSH250077 WAYNE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
WAYNE GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250077
Entity Address
950 MATTHEW DRIVE
WAYNESBORO, MS 39367
Medicare Provider Number
250077
Participating Start Date
4/1/2010
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #12929
804 SPRING STREET
WAYNESBORO, MS 39367
Pharmacy Comments
Contract Details
Approval Date
1/6/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathy Waddell, CEO
(601) 735-5151 Ext: 100
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/6/2021
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