Contract Pharmacy Details

WALGREEN CO.
DSH180048 EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER, INC.

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 #19533
343 N WALLACE WILKINSON BLVD
LIBERTY, KY 42539

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

2/22/2022
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

340B Drug Pricing Program Database