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WALGREEN CO.
DSH340032 GASTON MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
GASTON MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340032
Entity Address
2525 COURT DRIVE
GASTONIA, NC 28054
Medicare Provider Number
340032
Participating Start Date
1/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #10838
5220 HIGHWAY 557
CLOVER, SC 29710
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
David O’Connor, CFO
(704) 834-2127
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/17/2022
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