Contract Pharmacy Details

WALGREEN CO.
DSH340085 NOVANT HEALTH THOMASVILLE MEDICAL CENTER

Covered Entity Details

Entity Name

NOVANT HEALTH THOMASVILLE MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH340085

Entity Address

207 OLD LEXINGTON ROAD
THOMASVILLE, NC 27360

Medicare Provider Number

340085

Participating Start Date

7/1/2004

Last Recertification Date

8/23/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #15009
5496 UNIVERSITY PARKWAY
WINSTON SALEM, NC 27105-1366

Pharmacy Comments

Contract Details

Approval Date

4/11/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/16/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Geoffrey Gardner, SVP Finance
(336) 718-2078

Contract Pharmacy Representative

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

Signed By Date

4/11/2022

340B Drug Pricing Program Database