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WALGREEN CO
DSH110031 WellStar Spalding Regional Hospital
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Covered Entity Details
Entity Name
WellStar Spalding Regional Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110031
Entity Address
601 SOUTH 8TH STREET
GRIFFIN, GA 30224
Medicare Provider Number
110031
Participating Start Date
4/1/2017
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10632
1602 N EXPRESSWAY
GRIFFIN, GA 30223-1269
Pharmacy Comments
Contract Details
Approval Date
4/28/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Perrotti, CFO
(706) 845-3937
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/28/2017
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