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WALGREEN CO.
DSH510012 PLEASANT VALLEY HOSPITAL
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Covered Entity Details
Entity Name
PLEASANT VALLEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510012
Entity Address
2520 VALLEY DRIVE
POINT PLEASANT, WV 25550
Medicare Provider Number
510012
Participating Start Date
7/1/2006
Last Recertification Date
8/14/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #18006
2418 JACKSON AVE
POINT PLEASANT, WV 25550-2008
Pharmacy Comments
Contract Details
Approval Date
4/26/2018
Contract Begin Date
4/26/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Zach Kerns, CHIEF FINANCIAL OFFICER
(304) 675-6270
Contract Pharmacy Representative
Pleasant Valley Hospital
John Beaver, Pharmacy Director
(304) 675-4340 Ext: 1160
Signed By Date
4/26/2018
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