Contract Pharmacy Details

WALGREEN CO.
DSH450132 MEDICAL CENTER HOSPITAL

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 #15141
1707 W. 8TH ST.
ODESSA, TX 79763

Pharmacy Comments

Contract Details

Approval Date

7/11/2013

Contract Begin Date

10/1/2013

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

Jon E. Riggs, CFO
(432) 640-2407

Contract Pharmacy Representative

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

Signed By Date

7/11/2013

340B Drug Pricing Program Database