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WALGREEN CO
CAH261308-00 Washington County Memorial Hospital
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Covered Entity Details
Entity Name
Washington County Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261308-00
Entity Address
300 Health Way
Potosi, MO 63664
Medicare Provider Number
261308
Participating Start Date
4/1/2012
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10540
12977 STATE ROUTE 21
DE SOTO, MO 63020-1078
Pharmacy Comments
Contract Details
Approval Date
4/1/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Debra A Pratt, Chief Financial Officer
(573) 438-5451 Ext: 771
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/1/2022
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