340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALGREEN CO.
SCH260195-26 CITIZENS MEMORIAL HOSPITAL DISTRICT
Print
Covered Entity Details
Entity Name
CITIZENS MEMORIAL HOSPITAL DISTRICT
Subdivision Name
Bolivar Family Care Center - Bolivar Family Care Center
Type
Sole Community Hospital
340B ID
SCH260195-26
Entity Address
1240 North Butterfield
Bolivar, MO 65613
Medicare Provider Number
260195
Outpatient Facility Provider Number
268694
Participating Start Date
11/1/2021
Last Recertification Date
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16072
3537 BROADWAY BLVD
KANSAS CITY, MO 64111
Pharmacy Comments
Contract Details
Approval Date
11/1/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Renee Marie Meyer, Chief Financial Officer
(417) 328-6258
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/4/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session