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Walgreens MFC #21373
CAH191301-00 UNION GENERAL HOSPITAL
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Covered Entity Details
Entity Name
UNION GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH191301-00
Entity Address
901 JAMES AVE
FARMERVILLE, LA 71241
Medicare Provider Number
191301
Participating Start Date
4/1/2014
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
Walgreens MFC #21373
Pharmacy Address
4100 Dale Earnhardt Way
200
Northlake, TX 76262
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dianne Davidson, CHIEF EXECUTIVE OFFICER
(318) 368-7066
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2023
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