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WALGREEN CO.
DSH190040 Slidell Memorial Hospital
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Covered Entity Details
Entity Name
Slidell Memorial Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH190040
Entity Address
1001 Gause Boulevard
Slidell, LA 70458-2987
Medicare Provider Number
190040
Participating Start Date
10/1/2011
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 10273
2209 HIGHWAY 11 NORTH
PICAYUNE, MS 39466-2065
Pharmacy Comments
Contract Details
Approval Date
3/13/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bill Davis, Chief Executive Officer
(985) 280-8504
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/16/2013
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