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WALGREEN CO.
DSH510038 STONEWALL JACKSON MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
STONEWALL JACKSON MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510038
Entity Address
230 Hospital Plaza
WESTON, WV 26452
Medicare Provider Number
510038
Participating Start Date
1/1/2019
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
RITE AID #01305
218 E 3RD ST.
WESTON, WV 26452
Pharmacy Comments
Contract Details
Approval Date
10/8/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/17/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Kevin Stalnaker, Chief Administrative Officer
(304) 269-8152
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/8/2018
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