Contract Pharmacy Details

WALGREEN CO.
DSH450015 DALLAS COUNTY HOSPITAL DISTRICT dba PARKLAND HEALTH

Covered Entity Details

Entity Name

DALLAS COUNTY HOSPITAL DISTRICT dba PARKLAND HEALTH

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH450015

Entity Address

5200 Harry Hines Blvd
Dallas, TX 75235

Medicare Provider Number

450015

Participating Start Date

12/1/1992

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 06663
4201 E RENNER ROAD
RICHARDSON, TX 75082-2822

Pharmacy Comments

Contract Details

Approval Date

5/31/2012

Contract Begin Date

5/31/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/31/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

JOHN DRAGOVITS, EXCEUTIVE VICE PRESIDENT AND CFO
(214) 590-8097

Contract Pharmacy Representative

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

Signed By Date

5/15/2012

340B Drug Pricing Program Database