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WALGREEN CO.
DSH100063 MORTON PLANT NORTH BAY HOSPITAL
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Covered Entity Details
Entity Name
MORTON PLANT NORTH BAY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100063
Entity Address
6600 MADISON STREET
NEW PORT RICHEY, FL 34652-1971
Medicare Provider Number
100063
Participating Start Date
1/1/2015
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05132
6302 US HIGHWAY 19
NEW PORT RICHEY, FL 34652
Pharmacy Comments
Contract Details
Approval Date
10/15/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/30/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Carl Tremonti, Chief Financial Officer
(813) 870-4020
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2015
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