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WALGREEN CO.
DSH490037 RIVERSIDE SHORE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
RIVERSIDE SHORE MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490037
Entity Address
20480 Market Street
Onancock, VA 23417
Medicare Provider Number
490037
Participating Start Date
7/1/2004
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #18229
4053 LANKFORD HWY
P.O. BOX 850
EXMORE, VA 23350-2643
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
WILLIAM W. AUSTIN JR., SENIOR VP & CFO
(757) 534-7015
Contract Pharmacy Representative
Walgreens
Betsy Mileski, Regional Director
(757) 206-7446
Signed By Date
7/15/2019
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