Contract Pharmacy Details

WALGREEN CO.
DSH110107 Atrium Health Navicent The Medical Center

Covered Entity Details

Entity Name

Atrium Health Navicent The Medical Center

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH110107

Entity Address

777 HEMLOCK ST.
MACON, GA 31201-2102

Medicare Provider Number

110107

Participating Start Date

12/1/1992

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 06560
3888 VINEVILLE AVE
MACON, GA 31204-1865

Pharmacy Comments

Contract Details

Approval Date

12/13/2012

Contract Begin Date

1/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/1/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Don Faulk, CEO
(478) 633-6805

Contract Pharmacy Representative

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

Signed By Date

10/29/2012

340B Drug Pricing Program Database