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WALGREEN CO.
DSH420049 CONWAY HOSPITAL
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Covered Entity Details
Entity Name
CONWAY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420049
Entity Address
300 SINGLETON RIDGE ROAD
CONWAY, SC 29526
Medicare Provider Number
420049
Participating Start Date
7/1/2019
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #16172
808 E 5TH ST
TABOR CITY, NC 28463
Pharmacy Comments
Contract Details
Approval Date
4/7/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/24/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Bret Alan Barr, CEO
(843) 347-8114
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/7/2022
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