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WALGREEN CO.
DSH420018 PRISMA HEALTH RICHLAND HOSPITAL
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Covered Entity Details
Entity Name
PRISMA HEALTH RICHLAND HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420018
Entity Address
5 Richland Medical Park Drive
COLUMBIA, SC 29203
Medicare Provider Number
420018
Participating Start Date
8/1/1993
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09487
1223 ST ANDREWS RD
COLUMBIA, SC 29210-5821
Pharmacy Comments
Contract Details
Approval Date
4/5/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David F. Lee, Director of Financial Forecasting
(803) 296-3632
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/5/2013
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