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WALGREEN CO.
DSH450054 SCOTT AND WHITE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
SCOTT AND WHITE MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450054
Entity Address
2401 S 31ST ST
TEMPLE, TX 76508
Medicare Provider Number
450054
Participating Start Date
4/1/2006
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 10392
100 LAKE ROAD
BELTON, TX 76513-1510
Pharmacy Comments
Contract Details
Approval Date
5/4/2012
Contract Begin Date
5/4/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dick Dixon, CFO
(254) 724-4733
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
5/15/2012
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