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WALGREEN CO.
DSH440049 METHODIST HEALTHCARE - MEMPHIS HOSPITALS
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Covered Entity Details
Entity Name
METHODIST HEALTHCARE - MEMPHIS HOSPITALS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440049
Entity Address
1265 Union Ave
Memphis, TN 38104
Medicare Provider Number
440049
Participating Start Date
7/1/2004
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04016
2879 N GERMANTOWN PARKWAY
MEMPHIS, TN 38133
Pharmacy Comments
Contract Details
Approval Date
9/20/2011
Contract Begin Date
9/20/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/4/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
CHRIS MCLEAN, SENIOR VP/CFO
(901) 516-0753
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
9/6/2011
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