Contract Pharmacy Details

WALGREEN CO.
DSH340069 WAKEMED

Covered Entity Details

Entity Name

WAKEMED

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH340069

Entity Address

3000 NEW BERN AVENUE
RALEIGH, NC 27610

Medicare Provider Number

340069

Participating Start Date

1/1/2016

Last Recertification Date

8/14/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #19403
3432 EDWARDS MILL RD
RALEIGH, NC 27612

Pharmacy Comments

Contract Details

Approval Date

3/16/2018

Contract Begin Date

3/19/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

DONALD GINTZIG, President and CEO
(919) 350-8102

Contract Pharmacy Representative

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

Signed By Date

3/16/2018

340B Drug Pricing Program Database