Contract Pharmacy Details

WALGREEN CO.
DSH440073A MAURY REGIONAL HOSPITAL

Covered Entity Details

Entity Name

MAURY REGIONAL HOSPITAL

Subdivision Name

IV Therapy/Infusion Center

Type

Disproportionate Share Hospital

340B ID

DSH440073A

Entity Address

808 S. James Campbell Blvd.
Columbia, TN 38401

Medicare Provider Number

440073

Outpatient Facility Provider Number

Participating Start Date

7/20/2022

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 07659
1202 S JAMES CAMPBELL BLVD
COLUMBIA, TN 38401

Pharmacy Comments

Contract Details

Approval Date

9/29/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/17/2023
Agreement registered in error

Contacts

Covered Entity Signing Official

Martin Chaney, Chief Executive Officer
(931) 380-4008

Contract Pharmacy Representative

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

Signed By Date

9/29/2022

340B Drug Pricing Program Database