340B Drug Pricing Program Database
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WALGREEN CO.
DSH260009 BOTHWELL REGIONAL HEALTH CENTER
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Covered Entity Details
Entity Name
BOTHWELL REGIONAL HEALTH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260009
Entity Address
601 E. 14TH STREET
SEDALIA, MO 65301
Medicare Provider Number
260009
Participating Start Date
10/1/2023
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09382
412 PAWNEE STREET
CLINTON, MO 64735-2481
Pharmacy Comments
Contract Details
Approval Date
10/18/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steven R Davis, Chief Financial Officer
(660) 829-7790
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/18/2023
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