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Walgreens #21389
DSH440049 METHODIST HEALTHCARE - MEMPHIS HOSPITALS
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Covered Entity Details
Entity Name
METHODIST HEALTHCARE - MEMPHIS HOSPITALS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440049
Entity Address
1265 Union Ave
Memphis, TN 38104
Medicare Provider Number
440049
Participating Start Date
7/1/2004
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
Walgreens #21389
Pharmacy Address
Walgreens Central Fill #21389
3299 Tchulatech Dr
Suite 101
Memphis, TN 38118
Pharmacy Comments
Contract Details
Approval Date
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chuck Lane, SVP/Associate CFO
(901) 516-0549
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/11/2023
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