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WALGREEN CO.
DSH010087 USA Health University Hospital
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Covered Entity Details
Entity Name
USA Health University Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010087
Entity Address
2451 University Hospital Drive
MOBILE, AL 36617
Medicare Provider Number
010087
Participating Start Date
10/1/2003
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS SPECIALTY PHARMACY #12146
1200 KUHL AVE
ORLANDO, FL 32806
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/15/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
WILLIAM B. BUSH, CFO
(251) 471-7114
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2014
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