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WALGREEN CO.
DSH450132 MEDICAL CENTER HOSPITAL
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Covered Entity Details
Entity Name
MEDICAL CENTER HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450132
Entity Address
500 WEST 4TH ST.
ODESSA, TX 79761-5001
Medicare Provider Number
450132
Participating Start Date
4/1/1998
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06122
215 ANDREWS HWY
MIDLAND, TX 79701-6391
Pharmacy Comments
Contract Details
Approval Date
5/2/2012
Contract Begin Date
5/2/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/11/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert Abernethy, CFO
(432) 640-2407
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
5/4/2012
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