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WALGREEN CO.
DSH360076 ATRIUM MEDICAL CENTER
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Covered Entity Details
Entity Name
ATRIUM MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360076
Entity Address
ONE MEDICAL CENTER DRIVE
MIDDLETOWN, OH 45005-1006
Medicare Provider Number
360076
Participating Start Date
10/1/2020
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06471
700 S BREIEL BLVD
MIDDLETOWN, OH 45044
Pharmacy Comments
Contract Details
Approval Date
7/19/2021
Contract Begin Date
7/20/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Craig Allen Ganger, Chief Financial Officer
(937) 499-9988
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/19/2021
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