Contract Pharmacy Details

WALGREEN CO.
FQHCLA274 GENESIS HEALTH CARE, INC.

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
101 ALLIANCE PARKWAY
WILLIAMSTON, SC 29697-9103

Pharmacy Comments

Distribution Center

Contract Details

Approval Date

10/19/2012

Contract Begin Date

10/19/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/24/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Tony R. Megna, CEO
(803) 254-3676

Contract Pharmacy Representative

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

Signed By Date

9/28/2012

340B Drug Pricing Program Database