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WALGREENS SPECIALTY PHARMACY, LLC
DSH110143 COBB HOSPITAL, INC.
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Covered Entity Details
Entity Name
COBB HOSPITAL, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110143
Entity Address
3950 AUSTELL ROAD
AUSTELL, GA 30106
Medicare Provider Number
110143
Participating Start Date
10/1/2004
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
10/14/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DAROLD ETHERIDGE, CFO
(470) 732-5039
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/14/2016
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