Contract Pharmacy Details

WALGREEN CO.
DSH100025 SACRED HEART HEALTH SYSTEM

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 # 15616
5149 N. 9TH AVE SUITE 1137
PENSACOLA, FL 32504

Pharmacy Comments

06/17/13- Undelete per OPA instructions. Deleted per OPA instructions on 4/18/13.

Contract Details

Approval Date

4/5/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2024
Business decision by covered entity and/or pharmacy

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

1/14/2013

340B Drug Pricing Program Database