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HAPPY HARRY'S INC.
DSH080006 NANTICOKE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
NANTICOKE MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH080006
Entity Address
801 MIDDLEFORD ROAD
SEAFORD, DE 19973
Medicare Provider Number
080006
Participating Start Date
1/1/2009
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
HAPPY HARRY'S INC.
Pharmacy Address
DBA: WALGREENS #13003
9202 COMMERCIAL CENTRE DR
BRIDGEVILLE, DE 19933
Pharmacy Comments
Contract Details
Approval Date
1/8/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Donald Tricarico, VP, Clinical Services
(302) 629-6611 Ext: 2266
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/8/2015
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