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WALGREEN CO.
PED453306-00 Methodist Children's Hospital d/b/a Covenant Children's Hospital
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Covered Entity Details
Entity Name
Methodist Children's Hospital d/b/a Covenant Children's Hospital
Subdivision Name
Type
Children's Hospital
340B ID
PED453306-00
Entity Address
4015 22nd Place
Lubbock, TX 79410
Medicare Provider Number
453306
Participating Start Date
1/1/2018
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #21172
2701 N MESA ST STE 100A
EL PASO, TX 79902
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
DyAna Kerr, CFO
(806) 725-5234
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2022
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