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WALGREEN CO.
DSH260163 PARKLAND HEALTH CENTER
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Covered Entity Details
Entity Name
PARKLAND HEALTH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260163
Entity Address
1101 WEST LIBERTY ST
FARMINGTON, MO 63640
Medicare Provider Number
260163
Participating Start Date
10/1/2018
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #15820
605 N MAIN STREET
IRONTON, MO 63650
Pharmacy Comments
Contract Details
Approval Date
4/12/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cheri L Goldsmith, Director Finance
(573) 760-8036
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2022
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