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WALGREEN CO.
DSH100039 BROWARD HEALTH MEDICAL CENTER
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Covered Entity Details
Entity Name
BROWARD HEALTH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100039
Entity Address
1600 SOUTH ANDREWS AVE.
FORT LAUDERDALE, FL 33316
Medicare Provider Number
100039
Participating Start Date
7/1/2003
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04569
3895 W BROWARD BLVD
FORT LAUDERDALE, FL 33312-1017
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alex Fernandez, CFO
(954) 355-5841
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2018
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