Contract Pharmacy Details

WALGREEN CO.
RRC010024-00 JACKSON HOSPITAL AND CLINIC INC

Covered Entity Details

Entity Name

JACKSON HOSPITAL AND CLINIC INC

Subdivision Name

Type

Rural Referral Center

340B ID

RRC010024-00

Entity Address

1725 PINE STREET
MONTGOMERY, AL 36106-1109

Medicare Provider Number

010024

Participating Start Date

4/1/2017

Last Recertification Date

9/6/2022

Entity Termination Date

9/7/2022

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 06843
2281 E SOUTH BLVD
MONTGOMERY, AL 36116-2488

Pharmacy Comments

Contract Details

Approval Date

4/6/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/7/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Joe Riley, CEO
(334) 293-8809

Contract Pharmacy Representative

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

Signed By Date

4/6/2021

340B Drug Pricing Program Database