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WALGREEN CO.
DSH260137 FREEMAN HEALTH SYSTEM
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Covered Entity Details
Entity Name
FREEMAN HEALTH SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260137
Entity Address
1102 WEST 32ND STREET
JOPLIN, MO 64804-3503
Medicare Provider Number
260137
Participating Start Date
4/1/2004
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09467
880 S NEOSHO BLVD
NEOSHO, MO 64850-2052
Pharmacy Comments
Contract Details
Approval Date
4/18/2012
Contract Begin Date
4/18/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DEBI KOELKEBECK, VP, RETAIL/CLINICAL OPERATIONS
(417) 347-3074
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/19/2012
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