340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALGREEN CO.
DSH110095 TIFT REGIONAL HEALTH SYSTEM, INC
Print
Covered Entity Details
Entity Name
TIFT REGIONAL HEALTH SYSTEM, INC
Subdivision Name
DBA TIFT REGIONAL MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH110095
Entity Address
901 E. 18TH ST.
TIFTON, GA 31794
Medicare Provider Number
110095
Participating Start Date
7/1/2004
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #13641
35 COLLIER ROAD NW SUITE 100
ATLANTA, GA 30309
Pharmacy Comments
Contract Details
Approval Date
10/14/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Troy Buren Brooks, SVP/CFO
(229) 353-3397
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/14/2023
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session