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WALGREEN CO.
DSH450102 CHRISTUS MOTHER FRANCES HOSP-TYLER
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Covered Entity Details
Entity Name
CHRISTUS MOTHER FRANCES HOSP-TYLER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450102
Entity Address
800 EAST DAWSON
TYLER, TX 75701
Medicare Provider Number
450102
Participating Start Date
3/10/2022
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #21460
706 W MAIN ST
VAN, TX 75790
Pharmacy Comments
Contract Details
Approval Date
10/11/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eric Garrison, CFO
(903) 606-4102
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2023
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