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WALGREEN CO.
RRC170006-00 Mercy Hospital Pittsburg, Inc.
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Covered Entity Details
Entity Name
Mercy Hospital Pittsburg, Inc.
Subdivision Name
Type
Rural Referral Center
340B ID
RRC170006-00
Entity Address
1 MT. CARMEL WAY
1102 EAST CENTENNIAL
PITTSBURG, KS 66762
Medicare Provider Number
170006
Participating Start Date
9/24/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09049
1911 N BROADWAY STREET
PITTSBURG, KS 66762-2811
Pharmacy Comments
Contract Details
Approval Date
4/7/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/15/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MIKE JOY, CFO
(620) 232-0114
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/7/2014
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