Contract Pharmacy Details

WALGREEN CO.
DSH450475 East Texas Medical Center Henderson

Covered Entity Details

Entity Name

East Texas Medical Center Henderson

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH450475

Entity Address

300 WILSON STREET
HENDERSON, TX 75652

Medicare Provider Number

450475

Participating Start Date

1/1/2008

Last Recertification Date

11/9/2017

Entity Termination Date

4/1/2018

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #11212
2126 US HIGHWAY 79 SOUTH
HENDERSON, TX 75654-4409

Pharmacy Comments

Contract Details

Approval Date

1/9/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

MARK LEITNER, CEO
(903) 655-3616

Contract Pharmacy Representative

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

Signed By Date

1/9/2014

340B Drug Pricing Program Database