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WALGREEN CO.
DSH440152 Regional One Health
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Covered Entity Details
Entity Name
Regional One Health
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440152
Entity Address
877 JEFFERSON AVENUE
MEMPHIS, TN 38103
Medicare Provider Number
440152
Participating Start Date
4/1/1993
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06754
4028 GOODMAN ROAD WEST
HORN LAKE, MS 38637
Pharmacy Comments
Contract Details
Approval Date
10/6/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Kevin Proctor, SVP/CFO
(901) 545-8254
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/6/2021
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