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WALGREEN CO
CAH111310-00 MEDICAL CENTER OF PEACH COUNTY
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Covered Entity Details
Entity Name
MEDICAL CENTER OF PEACH COUNTY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH111310-00
Entity Address
1960 HIGHWAY 247 CONNECTOR
BYRON, GA 31008
Medicare Provider Number
111310
Participating Start Date
10/1/2015
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #11348
2835 WATSON BLVD
WARNER ROBINS, GA 31093
Pharmacy Comments
Contract Details
Approval Date
4/24/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/9/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Darren R Pearce, CEO
(478) 747-0089 Ext: 100
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/24/2017
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