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WALGREEN CO.
DSH110076 DEKALB MEDICAL CENTER, INC - DBA EMORY DECATUR HOSPITAL
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Covered Entity Details
Entity Name
DEKALB MEDICAL CENTER, INC - DBA EMORY DECATUR HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110076
Entity Address
2701 NORTH DECATUR ROAD
DECATUR, GA 30033
Medicare Provider Number
110076
Participating Start Date
4/1/2002
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07394
3740 CASCADE RD SW
ATLANTA, GA 30331
Pharmacy Comments
Contract Details
Approval Date
12/17/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JOHN SHELTON, President and Chief Executive Officer
(404) 501-5209
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/26/2012
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