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WALGREEN CO.
DSH490024 CARILION MEDICAL CENTER
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Covered Entity Details
Entity Name
CARILION MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490024
Entity Address
1906 BELLEVIEW AVE SE
ROANOKE, VA 24014
Medicare Provider Number
490024
Participating Start Date
10/1/2007
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #15112
1500 PINEY FOREST ROAD
DANVILLE, VA 24540
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/21/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Tim Auwarter, VP Hospital Operations
(540) 981-7804
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2019
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