Contract Pharmacy Details

WALGREEN CO.
SCH170120-00 LABETTE COUNTY MEDICAL CENTER D/B/A LABETTE HEALTH

Covered Entity Details

Entity Name

LABETTE COUNTY MEDICAL CENTER D/B/A LABETTE HEALTH

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH170120-00

Entity Address

1902 S US HWY 59
PARSONS, KS 67357

Medicare Provider Number

170120

Participating Start Date

1/1/2011

Last Recertification Date

8/13/2024

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

1/15/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

TOM MACARONAS, CFO
(620) 820-5251

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/15/2014

340B Drug Pricing Program Database