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Walgreens #21389
DSH010092 DCH REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
DCH REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010092
Entity Address
809 UNIVERSITY BOULEVARD EAST
TUSCALOOSA, AL 35401
Medicare Provider Number
010092
Participating Start Date
1/1/2004
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
Walgreens #21389
Pharmacy Address
Walgreens Central Fill #21389
3299 Tchulatech Dr
Suite 101
Memphis, TN 38118
Pharmacy Comments
Contract Details
Approval Date
10/10/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
NINA DUSANG, CFO
(205) 759-7738
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/10/2022
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