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WALGREEN CO.
DSH250077 WAYNE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
WAYNE GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250077
Entity Address
950 MATTHEW DRIVE
WAYNESBORO, MS 39367
Medicare Provider Number
250077
Participating Start Date
4/1/2010
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09037
419 N 16TH AVE
LAUREL, MS 39440-3850
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrew Porter, CEO
(601) 735-5151 Ext: 100
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2025
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