Contract Pharmacy Details

WALGREEN CO.
DSH490024 CARILION MEDICAL CENTER

Covered Entity Details

Entity Name

CARILION MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH490024

Entity Address

1906 BELLEVIEW AVE SE
ROANOKE, VA 24014

Medicare Provider Number

490024

Participating Start Date

10/1/2007

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #07605
2351 FRANKLIN RD. SW
ROANOKE, VA 24014

Pharmacy Comments

Contract Details

Approval Date

10/24/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Tim Auwarter, VP Hospital Operations
(540) 981-7804

Contract Pharmacy Representative

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

Signed By Date

10/24/2018

340B Drug Pricing Program Database