Contract Pharmacy Details

WALGREEN CO.
DSH450080 TITUS REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

TITUS REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH450080

Entity Address

2001 N. JEFFERSON
MT. PLEASANT, TX 75455

Medicare Provider Number

450080

Participating Start Date

7/1/2008

Last Recertification Date

8/30/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #12293
203 W FERGUSON RD
MOUNT PLEASANT, TX 75455

Pharmacy Comments

Contract Details

Approval Date

7/15/2021

Contract Begin Date

8/4/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Terry Scoggin, CEO
(903) 577-6066

Contract Pharmacy Representative

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

Signed By Date

7/15/2021

340B Drug Pricing Program Database