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WALGREEN CO.
RRC340014-00 FORSYTH MEMORIAL HOSPITAL INC
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Covered Entity Details
Entity Name
FORSYTH MEMORIAL HOSPITAL INC
Subdivision Name
Type
Rural Referral Center
340B ID
RRC340014-00
Entity Address
3333 SILAS CREEK PARKWAY
WINSTON SALEM, NC 27103
Medicare Provider Number
340014
Participating Start Date
7/7/2020
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17235
3095 WAUGHTOWN ST
WINSTON-SALEM, NC 27107
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Geoffrey Gardner, SVP Finance
(336) 718-2078
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2021
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