Contract Pharmacy Details

WALGREEN CO.
DSH210008 MERCY MEDICAL CENTER

Covered Entity Details

Entity Name

MERCY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH210008

Entity Address

345 ST. PAUL PLACE
BALTIMORE, MD 21202

Medicare Provider Number

210008

Participating Start Date

10/1/2002

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 06265
9110 LIBERTY ROAD
RANDALLSTOWN, MD 21133

Pharmacy Comments

Contract Details

Approval Date

1/14/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/13/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Morrell Delcher, VP & Chief Pharmacy Officer
(410) 332-9627

Contract Pharmacy Representative

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

Signed By Date

1/14/2014

340B Drug Pricing Program Database