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WALGREEN CO.
DSH100087 SARASOTA MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
SARASOTA MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100087
Entity Address
1700 S. TAMIAMI TRAIL
SARASOTA, FL 34239-3509
Medicare Provider Number
100087
Participating Start Date
1/1/2015
Last Recertification Date
11/16/2017
Entity Termination Date
4/1/2018
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07875
1800 TAMIAMI TRAIL
PORT CHARLOTTE, FL 33948-1043
Pharmacy Comments
Contract Details
Approval Date
7/26/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/8/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
William Woeltjen, Chief Financial Officer
(941) 917-1280
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/26/2016
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