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WALGREEN CO.
PED093300-00 Children's National Medical Center
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Covered Entity Details
Entity Name
Children's National Medical Center
Subdivision Name
Type
Children's Hospital
340B ID
PED093300-00
Entity Address
111 Michigan Avenue, NW
Washington, DC 20010-2970
Medicare Provider Number
093300
Participating Start Date
10/1/2012
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #19268
1401 RHODE ISLAND AVE NE
WASHINGTON, DC 20018-3708
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
10/20/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/10/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Kathleen Gorman, EVP, Patient Care services & Chief Operating Officer
(202) 476-2939
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2021
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