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WALGREEN CO
DSH100025 SACRED HEART HEALTH SYSTEM
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Covered Entity Details
Entity Name
SACRED HEART HEALTH SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100025
Entity Address
5151 NORTH 9TH AVENUE
PENSACOLA, FL 32504
Medicare Provider Number
100025
Participating Start Date
7/1/2003
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10312
85 BEVERLY PKWY
PENSACOLA, FL 32505-2813
Pharmacy Comments
Contract Details
Approval Date
11/7/2012
Contract Begin Date
11/7/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Buddy Elmore, CFO
(850) 416-7638
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
11/7/2012
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