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WALGREEN CO.
FQHCLA274 GENESIS HEALTH CARE, INC.
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Covered Entity Details
Entity Name
GENESIS HEALTH CARE, INC.
Subdivision Name
Type
Health Center Program Look-Alike
340B ID
FQHCLA274
Entity Address
201 CASHUA STREET
DARLINGTON, SC 29532
Grant Number
LALCS00092
Participating Start Date
1/7/2011
Last Recertification Date
2/9/2015
Entity Termination Date
1/1/2016
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07155
1500 S IRBY STREET
FLORENCE, SC 29505-3408
Pharmacy Comments
Contract Details
Approval Date
8/17/2012
Contract Begin Date
8/17/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
TONY R. MEGNA, CEO
(803) 254-3676 Ext: 112
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
8/15/2012
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