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WALGREEN CO.
PED013301-00 USA Health Children's and Women's Hospital
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Covered Entity Details
Entity Name
USA Health Children's and Women's Hospital
Subdivision Name
Type
Children's Hospital
340B ID
PED013301-00
Entity Address
1700 Center Street
Mobile, AL 36604-3301
Medicare Provider Number
013301
Participating Start Date
7/1/2013
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #13159
9179 MOFFETT RD.
SEMMES, AL 36575
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/3/2015
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Bill Bush, CFO
(251) 471-7114
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2014
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