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WALGREEN CO.
DSH040051 Baptist Health Medical Center - Drew County
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Covered Entity Details
Entity Name
Baptist Health Medical Center - Drew County
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040051
Entity Address
778 SCOGIN DRIVE
MONTICELLO, AR 71655
Medicare Provider Number
040051
Participating Start Date
7/1/2010
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16545
1200 JOHN BARROW RD STE 102
LITTLE ROCK, AR 72205
Pharmacy Comments
Contract Details
Approval Date
4/14/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brent Beaulieu, CFO
(501) 202-2017
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/14/2025
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