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WALGREEN CO.
FQHCLA337 RURAL HEALTH ACCESS CORPORATION
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Covered Entity Details
Entity Name
RURAL HEALTH ACCESS CORPORATION
Subdivision Name
Coalfield Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA337
Entity Address
386 Airport Road
Chapmanville, WV 25508
Grant Number
LALCS00112
Participating Start Date
1/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17504
164 HOLDEN RD
MOUNT GAY, WV 25637
Pharmacy Comments
Contract Details
Approval Date
4/8/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/17/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Kristin Dial, Executive Director
(304) 855-1228
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/8/2019
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