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WALGREEN CO.
CAH111320-00 HIGGINS GENERAL HOSPITAL
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Covered Entity Details
Entity Name
HIGGINS GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH111320-00
Entity Address
200 ALLEN MEMORIAL DRIVE
BREMEN, GA 30110
Medicare Provider Number
111320
Participating Start Date
9/30/2010
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07820
794 SOUTH PARK ST
CARROLLTON, GA 30117-3825
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
Carol S. Crews, CFO
(770) 812-9745
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2022
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