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WALGREEN CO.
RRC450023-00 CITIZENS MEDICAL CENTER
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Covered Entity Details
Entity Name
CITIZENS MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC450023-00
Entity Address
2701 HOSPITAL DRIVE
VICTORIA, TX 77901
Medicare Provider Number
450023
Participating Start Date
7/1/2023
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12330
9005 N. NAVARRO
VICTORIA, TX 77904
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Duane L. Woods, CFO
(361) 572-5009
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/17/2023
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