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WALGREEN CO.
SCH420067-00 BEAUFORT MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BEAUFORT MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH420067-00
Entity Address
955 RIBAUT ROAD
BEAUFORT, SC 29902
Medicare Provider Number
420067
Participating Start Date
1/1/2015
Last Recertification Date
8/16/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07652
868 FORDING ISLAND RD
BLUFFTON, SC 29910
Pharmacy Comments
Contract Details
Approval Date
4/2/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/13/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jeffrey L. White, Senior Vice President & CFO
(843) 522-5142
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/2/2015
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