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WALGREEN CO
SCH260094-00 COX MEDICAL CENTER BRANSON
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Covered Entity Details
Entity Name
COX MEDICAL CENTER BRANSON
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260094-00
Entity Address
525 Branson Landing Blvd
Branson, MO 65616
Medicare Provider Number
260094
Participating Start Date
7/1/2022
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #12268
101 INDUSTRIAL PARK DRIVE
HOLLISTER, MO 65672
Pharmacy Comments
Contract Details
Approval Date
10/18/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
DAVID Lee STRONG, CFO
(417) 335-7188
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/18/2016
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