Contract Pharmacy Details

WALGREEN CO.
CAH111328-00 Phoebe Worth Medical Center

Covered Entity Details

Entity Name

Phoebe Worth Medical Center

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH111328-00

Entity Address

807 South Isabella Street
Sylvester, GA 31791-0545

Medicare Provider Number

111328

Participating Start Date

10/1/2011

Last Recertification Date

8/27/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #12756
2025 FIRST AVENUE SE
MOULTRIE, GA 31788

Pharmacy Comments

Contract Details

Approval Date

10/25/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Candace Guarnieri, VP of Finance
(229) 777-3851

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/25/2021

340B Drug Pricing Program Database