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WALGREEN CO
CAH111306-00 EFFINGHAM HEALTH SYSTEM
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Covered Entity Details
Entity Name
EFFINGHAM HEALTH SYSTEM
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH111306-00
Entity Address
459 HIGHWAY 119 SOUTH
SPRINGFIELD, GA 31329-3021
Medicare Provider Number
111306
Participating Start Date
1/1/2011
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10799
409 S COLUMBIA AVE
RINCON, GA 31326
Pharmacy Comments
Contract Details
Approval Date
2/1/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Fran Baker-Witt, CEO
(912) 754-3822
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
2/1/2017
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