Contract Pharmacy Details

WALGREEN CO.
DSH440104 Erlanger Health

Covered Entity Details

Entity Name

Erlanger Health

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH440104

Entity Address

975 East Third Street
CHATTANOOGA, TN 37403

Medicare Provider Number

440104

Participating Start Date

12/1/1992

Last Recertification Date

9/11/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 07312
4810 ROSSVILLE BLVD
CHATTANOOGA, TN 37407-3524

Pharmacy Comments

Contract Details

Approval Date

6/15/2012

Contract Begin Date

6/15/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/9/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

BRITTON J. TABOR, CFO
(423) 778-7729

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

6/15/2012

340B Drug Pricing Program Database