Contract Pharmacy Details

WALGREEN CO.
DSH440049 METHODIST HEALTHCARE - MEMPHIS HOSPITALS

Covered Entity Details

Entity Name

METHODIST HEALTHCARE - MEMPHIS HOSPITALS

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH440049

Entity Address

1265 Union Ave
Memphis, TN 38104

Medicare Provider Number

440049

Participating Start Date

7/1/2004

Last Recertification Date

9/6/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

RITE AID #07193
1810 UNION AVENUE
MEMPHIS, TN 38104

Pharmacy Comments

Contract Details

Approval Date

1/4/2018

Contract Begin Date

1/4/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/5/2018
Pharmacy closed

Contacts

Covered Entity Signing Official

CHRIS MCLEAN, SENIOR VP/CFO
(901) 516-0753

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/4/2018

340B Drug Pricing Program Database