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WALGREEN CO.
DSH340053 Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center
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Covered Entity Details
Entity Name
Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340053
Entity Address
200 HAWTHORNE LANE
CHARLOTTE, NC 28204
Medicare Provider Number
340053
Participating Start Date
4/1/2008
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #19702
8520 PARK RD
CHARLOTTE, NC 28210
Pharmacy Comments
Contract Details
Approval Date
1/9/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rebecca A Bean, SVP Chief Pharmacy Executive
(336) 277-5862
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/9/2025
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