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Walgreens #21389
CAH141321-00 Franklin Hospital District
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Covered Entity Details
Entity Name
Franklin Hospital District
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141321-00
Entity Address
201 Bailey Lane
Benton, IL 62812-1999
Medicare Provider Number
141321
Participating Start Date
1/1/2013
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
Walgreens #21389
Pharmacy Address
Walgreens Central Fill #21389
3299 Tchulatech Dr
Suite 101
Memphis, TN 38118
Pharmacy Comments
Contract Details
Approval Date
4/14/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Rikki S. Bonthron, CFO
(618) 439-3161 Ext: 9601
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/14/2022
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