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WALGREEN CO.
DSH440050 Greeneville Community Hospital
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Covered Entity Details
Entity Name
Greeneville Community Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440050
Entity Address
1420 Tusculum Blvd
GREENEVILLE, TN 37745
Medicare Provider Number
440050
Participating Start Date
7/1/2009
Last Recertification Date
8/30/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07049
1650 E ANDREW JOHNSON HWY
GREENEVILLE, TN 37745-4274
Pharmacy Comments
Contract Details
Approval Date
1/12/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Todd j. Dougan, CFO
(423) 230-8512
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/12/2018
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