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WALGREEN CO
DSH250006 BAPTIST MEMORIAL HOSPITAL - UNION COUNTY
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Covered Entity Details
Entity Name
BAPTIST MEMORIAL HOSPITAL - UNION COUNTY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250006
Entity Address
200 STATE HIGHWAY 30 W
NEW ALBANY, MS 38652-3112
Medicare Provider Number
250006
Participating Start Date
9/4/2008
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #12436
225 HWY 30 W
NEW ALBANY, MS 38652-3129
Pharmacy Comments
Contract Details
Approval Date
4/26/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
WALTER GRACE, CEO AND ADMINISTRATOR
(662) 538-2100
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/26/2013
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