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WALGREEN CO.
DSH110226 DEKALB MEDICAL CENTER AT HILLANDALE - DBA EMORY HILLANDALE HOSPITAL
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Covered Entity Details
Entity Name
DEKALB MEDICAL CENTER AT HILLANDALE - DBA EMORY HILLANDALE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110226
Entity Address
2801 DEKALB MEDICAL PARKWAY
LITHONIA, GA 30058
Medicare Provider Number
110226
Participating Start Date
10/1/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06032
595 PIEDMONT AVE NE STE 100
ATLANTA, GA 30308-2480
Pharmacy Comments
Contract Details
Approval Date
2/14/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JOHN SHELTON, President and Chief Executive Officer
(404) 501-5209
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/16/2013
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