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WALGREEN CO.
DSH440131 BAPTIST MEMORIAL HOSPITAL- TIPTON
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Covered Entity Details
Entity Name
BAPTIST MEMORIAL HOSPITAL- TIPTON
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440131
Entity Address
1995 HIGHWAY 51 S
COVINGTON, TN 38019-2338
Medicare Provider Number
440131
Participating Start Date
9/4/2008
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07613
3515 PARK AVENUE
MEMPHIS, TN 38111-5621
Pharmacy Comments
Contract Details
Approval Date
4/15/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/7/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Monique Hart, Chief Finanacial Officer
(901) 475-5526
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2013
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