Contract Pharmacy Details

WALGREEN CO.
CAH151319-00 Gibson General Hospital, Inc

Covered Entity Details

Entity Name

Gibson General Hospital, Inc

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH151319-00

Entity Address

1808 Sherman Drive
Princeton, IN 47670

Medicare Provider Number

151319

Participating Start Date

1/1/2012

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #16372
532 S 4TH ST UNIT 532
LOUISVILLE, KY 40202

Pharmacy Comments

Contract Details

Approval Date

10/1/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/29/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Lois Morgan, VP/Chief Nursing Officer
(812) 385-9237

Contract Pharmacy Representative

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

Signed By Date

10/1/2018

340B Drug Pricing Program Database