Contract Pharmacy Details

WALGREEN CO.
CAH181328-00 ARH Mary Breckinridge Health Services, Inc.

Covered Entity Details

Entity Name

ARH Mary Breckinridge Health Services, Inc.

Subdivision Name

Barbourville ARH Hospital

Type

Critical Access Hospital

340B ID

CAH181328-00

Entity Address

80 HOSPITAL DRIVE
BARBOURVILLE, KY 40906

Medicare Provider Number

181328

Participating Start Date

1/1/2016

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #18301
1320 CUMBERLAND FALLS HWY
CORBIN, KY 40701

Pharmacy Comments

Contract Details

Approval Date

10/10/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/17/2025
Pharmacy closed

Contacts

Covered Entity Signing Official

Joseph Grossman, PRESIDENT and CEO
(859) 226-2450

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/10/2019

340B Drug Pricing Program Database