340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALGREEN CO
DSH100088 BAPTIST MEDICAL CENTER
Print
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 #11580
1215 DUNN AVENUE, SUITE #2
JACKSONVILLE, FL 32218
Pharmacy Comments
Contract Details
Approval Date
1/24/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/24/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Scott M. Wooten, SVP & CFO
(904) 202-3405
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/24/2017
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session