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WALGREEN CO.
DSH100052 WINTER HAVEN HOSPITAL
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Covered Entity Details
Entity Name
WINTER HAVEN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100052
Entity Address
200 AVENUE F, NE
WINTER HAVEN, FL 33881
Medicare Provider Number
100052
Participating Start Date
1/1/2008
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11190
24170 HWY 27
LAKE WALES, FL 33859
Pharmacy Comments
Contract Details
Approval Date
10/15/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Carl Tremonti, Chief Financial Officer
(813) 870-4020
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2015
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