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WALGREEN CO.
CAH441309-00 MARSHALL MEDICAL CENTER
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Covered Entity Details
Entity Name
MARSHALL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH441309-00
Entity Address
1080 NORTH ELLINGTON PKWY
LEWISBURG, TN 37091
Medicare Provider Number
441309
Participating Start Date
9/21/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #21215
309C 22ND AVE N
NASHVILLE, TN 37203
Pharmacy Comments
Contract Details
Approval Date
4/5/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PHYLLIS BROWN, CHIEF EXECUTIVE OFFICER
(931) 359-6241 Ext: 3306
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/5/2024
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