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WALGREEN CO.
DSH440048 BAPTIST MEM HOSPITAL MEMPHIS
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Covered Entity Details
Entity Name
BAPTIST MEM HOSPITAL MEMPHIS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440048
Entity Address
6019 WALNUT GROVE ROAD
MEMPHIS, TN 38120
Medicare Provider Number
440048
Participating Start Date
7/1/2017
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04455
35 STATELINE RD WEST
SOUTHAVEN, MS 38671
Pharmacy Comments
Contract Details
Approval Date
12/14/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Barham, VP, Operations Finance CFO
(901) 227-7467
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
12/14/2017
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