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WALGREEN CO.
DSH450848 Memorial Hermann Sugar Land Hospital
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Covered Entity Details
Entity Name
Memorial Hermann Sugar Land Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450848
Entity Address
17500 West Grand Parkway
Sugar Land, TX 77479
Medicare Provider Number
450848
Participating Start Date
1/1/2012
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11909
3902 FM 762
ROSENBERG, TX 77469
Pharmacy Comments
Contract Details
Approval Date
1/14/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/14/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gregory Haralson, CEO
(281) 725-5210
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2014
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