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WALGREEN CO.
DSH250025 MONROE HEALTH SERVICES INC.
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Covered Entity Details
Entity Name
MONROE HEALTH SERVICES INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250025
Entity Address
1105 EARL FRYE BLVD
AMORY, MS 38821
Medicare Provider Number
250025
Participating Start Date
7/1/2021
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17341
200 HIGHWAY 145 N
ABERDEEN, MS 39730
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRUCE J. TOPPIN, GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY
(662) 377-4229
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2022
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