Contract Pharmacy Details

WALGREEN CO.
RRC360147-00 MARIETTA MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

MARIETTA MEMORIAL HOSPITAL

Subdivision Name

Type

Rural Referral Center

340B ID

RRC360147-00

Entity Address

401 MATTHEW STREET
MARIETTA, OH 45750

Medicare Provider Number

360147

Participating Start Date

1/1/2015

Last Recertification Date

8/21/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #18423
1490 E MAIN ST.
HARRISVILLE, WV 26362-7700

Pharmacy Comments

Contract Details

Approval Date

1/10/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Joseph Hupp, SR Director of Finance / Interim CFO
(740) 374-1546

Contract Pharmacy Representative

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

Signed By Date

1/10/2019

340B Drug Pricing Program Database