Contract Pharmacy Details

WALGREEN CO
DSH010099 D W MCMILLAN MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

D W MCMILLAN MEMORIAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH010099

Entity Address

1301 BELLEVILLE AVENUE
BREWTON, AL 36427

Medicare Provider Number

010099

Participating Start Date

11/15/2022

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA: WALGREENS #10761
1504 S MAIN STREET
ATMORE, AL 36502-0337

Pharmacy Comments

Contract Details

Approval Date

10/7/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Chris B. Griffin, Administrator
(251) 867-8061

Contract Pharmacy Representative

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

Signed By Date

10/7/2014

340B Drug Pricing Program Database