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WALGREEN CO.
DSH420070 PRISMA HEALTH TUOMEY HOSPITAL
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Covered Entity Details
Entity Name
PRISMA HEALTH TUOMEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420070
Entity Address
129 N WASHINGTON ST
SUMTER, SC 29150-4949
Medicare Provider Number
420070
Participating Start Date
4/1/2006
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09276
1990 MCCRAYS MILL RD.
SUMTER, SC 29150-6185
Pharmacy Comments
Contract Details
Approval Date
4/9/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mark Lovell, CFO
(877) 774-8616
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/9/2014
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