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WALGREEN CO
DSH110044 PHOEBE SUMTER MEDICAL CENTER
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Covered Entity Details
Entity Name
PHOEBE SUMTER MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110044
Entity Address
126 Hwy 280 West
AMERICUS, GA 31719
Medicare Provider Number
110044
Participating Start Date
7/1/2004
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #11106
733 E FORSYTH ST
AMERICUS, GA 31709-3718
Pharmacy Comments
Contract Details
Approval Date
10/18/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brandi Lee Lunneborg, Chief Executive Officer
(229) 931-1191
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/18/2021
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