Contract Pharmacy Details

WALGREEN CO.
DSH010078 NORTHEAST ALABAMA REGIONAL MED CTR

Covered Entity Details

Entity Name

NORTHEAST ALABAMA REGIONAL MED CTR

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH010078

Entity Address

400 EAST TENTH STREET
ANNISTON, AL 36207

Medicare Provider Number

010078

Participating Start Date

1/1/2016

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #11819
1401 GOLDEN SPRINGS RD
ANNISTON, AL 36207

Pharmacy Comments

Contract Details

Approval Date

1/12/2024

Contract Begin Date

4/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Mark North, Vice President - Finance/CFO
(256) 741-6370

Contract Pharmacy Representative

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

Signed By Date

1/12/2024

340B Drug Pricing Program Database