Contract Pharmacy Details

WALGREEN CO
SCH040067-00 MAGNOLIA REGIONAL HEALTH SYSTEM INC

Covered Entity Details

Entity Name

MAGNOLIA REGIONAL HEALTH SYSTEM INC

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH040067-00

Entity Address

101 Hospital Drive
MAGNOLIA, AR 71753

Medicare Provider Number

040067

Participating Start Date

7/1/2024

Last Recertification Date

9/9/2024

Entity Termination Date

7/1/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA: WALGREENS #10897
1644 E MAIN ST
MAGNOLIA, AR 71753-3804

Pharmacy Comments

Contract Details

Approval Date

4/23/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Brett Kinman, CEO
(870) 235-3212

Contract Pharmacy Representative

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

Signed By Date

4/12/2024

340B Drug Pricing Program Database