Contract Pharmacy Details

WALGREEN CO.
DSH210001 MERITUS MEDICAL CENTER

Covered Entity Details

Entity Name

MERITUS MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH210001

Entity Address

11116 MEDICAL CAMPUS ROAD
HAGERSTOWN, MD 21742

Medicare Provider Number

210001

Participating Start Date

7/1/2018

Last Recertification Date

8/23/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #11677
101 FORBES DR.
MARTINSBURG, WV 25404-0002

Pharmacy Comments

Contract Details

Approval Date

7/7/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Carrie Adams, Chief Operating Officer
(301) 790-8102

Contract Pharmacy Representative

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

Signed By Date

7/7/2022

340B Drug Pricing Program Database