340B Drug Pricing Program Database
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WALGREEN CO.
DSH260024 TEXAS COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
TEXAS COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260024
Entity Address
1333 S SAM HOUSTON BLVD
HOUSTON, MO 65483
Medicare Provider Number
260024
Participating Start Date
4/1/2010
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #15054
124 W 2ND ST
MOUNTAIN VIEW, MO 65548
Pharmacy Comments
Contract Details
Approval Date
1/13/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LINDA PAMPERIEN, CFO
(417) 967-1255
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/13/2022
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