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WALGREEN CO
DSH110115 WellStar ATLANTA MEDICAL CENTER
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Covered Entity Details
Entity Name
WellStar ATLANTA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110115
Entity Address
303 PARKWAY DRIVE
ATLANTA, GA 30312
Medicare Provider Number
110115
Participating Start Date
4/1/2017
Last Recertification Date
8/30/2022
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #12604
340 BOULEVARD NE STE 143
ATLANTA, GA 30312
Pharmacy Comments
Contract Details
Approval Date
4/7/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/18/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Jason Limbaugh, CFO
(404) 265-4857
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/7/2017
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