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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
15998 WALGREENS DRIVE
JUPITER, FL 33478
Pharmacy Comments
Distribution Center
Contract Details
Approval Date
3/13/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/20/2015
Business decision by covered entity and/or pharmacy
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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