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WALGREEN CO.
DSH180048 EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180048
Entity Address
217 SOUTH THIRD STREET
DANVILLE, KY 40422
Medicare Provider Number
180048
Participating Start Date
10/1/2004
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #18083
154 PLEASANT RETREAT DR
LANCASTER, KY 40444
Pharmacy Comments
Contract Details
Approval Date
4/10/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/8/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
William M. SNAPP III, CFO
(859) 239-2424
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/10/2019
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