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WALGREEN CO.
CAH181328-00 ARH Mary Breckinridge Health Services, Inc.
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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
DBA: WALGREENS #18950
248 S. MAIN ST
JELLICO, TN 37762
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
3/7/2023
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
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