340B Drug Pricing Program Database
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WALGREEN CO.
DSH370089 TAHLEQUAH CITY HOSPITAL
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Covered Entity Details
Entity Name
TAHLEQUAH CITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370089
Entity Address
1400 E DOWNING
TAHLEQUAH, OK 74464
Medicare Provider Number
370089
Participating Start Date
4/1/2023
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16556
1611 E. 15TH ST.
TULSA, OK 74120
Pharmacy Comments
Contract Details
Approval Date
3/6/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/15/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JAMES BERRY, EXEC VICE PRESIDENT
(918) 453-2263
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/17/2023
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