Contract Pharmacy Details

WALGREEN CO.
CAH101314-00 Doctors Memorial Hospital, Inc.

Covered Entity Details

Entity Name

Doctors Memorial Hospital, Inc.

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH101314-00

Entity Address

333 N BYRON BUTLER PKWY
Perry, FL 32347

Medicare Provider Number

101314

Participating Start Date

11/16/2023

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #12578
2117 S BYRON BUTLER PKWY
PERRY, FL 32348

Pharmacy Comments

Contract Details

Approval Date

11/16/2023

Contract Begin Date

11/16/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Lauren Faison-Clark, CEO
(850) 584-0886

Contract Pharmacy Representative

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

Signed By Date

11/9/2023

340B Drug Pricing Program Database