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WALGREEN CO.
RRC110023-00 ADVENTHEALTH GORDON
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Covered Entity Details
Entity Name
ADVENTHEALTH GORDON
Subdivision Name
Type
Rural Referral Center
340B ID
RRC110023-00
Entity Address
1035 RED BUD ROAD
CALHOUN, GA 30703-7013
Medicare Provider Number
110023
Participating Start Date
7/1/2024
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17229
1101 RED BUD RD NE
CALHOUN, GA 30701
Pharmacy Comments
Contract Details
Approval Date
5/13/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steve Gotshall, CE-VP CFO AH
(706) 879-4710
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/14/2024
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