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WALGREEN CO.
CAH101312-00 Fishermen's Hospital
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Covered Entity Details
Entity Name
Fishermen's Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH101312-00
Entity Address
3301 Overseas Highway
Marathon, FL 33050
Medicare Provider Number
101312
Participating Start Date
1/1/2019
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03574
10870 OVERSEAS HIGHWAY
MARATHON, FL 33050
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Contacts
Covered Entity Signing Official
Hal Leftwich, Chief Executive Officer
(305) 289-6401
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/17/2016
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