Contract Pharmacy Details

WALGREEN CO.
DSH340091 THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION

Covered Entity Details

Entity Name

THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH340091

Entity Address

1200 NORTH ELM STREET
GREENSBORO, NC 27401-1020

Medicare Provider Number

340091

Participating Start Date

4/1/2006

Last Recertification Date

8/30/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

RITE AID #11356
500 PISGAH CHURCH RD
GREENSBORO, NC 27455

Pharmacy Comments

Contract Details

Approval Date

4/13/2018

Contract Begin Date

4/19/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/31/2018
Pharmacy closed

Contacts

Covered Entity Signing Official

Jeffrey Jones, Executive VP and CFO
(336) 832-8005

Contract Pharmacy Representative

Cone Health
Alex Kidd, Pharmacy Business Manager
(336) 890-3625

Signed By Date

4/13/2018

340B Drug Pricing Program Database