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WALGREEN CO.
DSH040154 BHMC-CONWAY
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Covered Entity Details
Entity Name
BHMC-CONWAY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040154
Entity Address
1555 EXCHANGE AVENUE
CONWAY, AR 72032
Medicare Provider Number
040154
Participating Start Date
10/1/2020
Last Recertification Date
9/12/2022
Entity Termination Date
7/1/2023
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 10170
505 SALEM ROAD
CONWAY, AR 72034-4815
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/17/2023
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