Contract Pharmacy Details

WALGREEN CO.
DSH100088 BAPTIST MEDICAL CENTER

Covered Entity Details

Entity Name

BAPTIST MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH100088

Entity Address

800 PRUDENTIAL DRIVE
JACKSONVILLE, FL 32207

Medicare Provider Number

100088

Participating Start Date

7/1/2006

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 04440
1320 BLANDING BLVD.
ORANGE PARK, FL 32065

Pharmacy Comments

Contract Details

Approval Date

10/14/2022

Contract Begin Date

1/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Scott Finnegan, Senior Vice President of Finance/Treasury
(904) 202-3270

Contract Pharmacy Representative

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

Signed By Date

10/14/2022

340B Drug Pricing Program Database