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WALGREEN CO.
DSH180050 HARLAN ARH HOSPITAL
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Covered Entity Details
Entity Name
HARLAN ARH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180050
Entity Address
81 BALL PARK ROAD
HARLAN, KY 40831
Medicare Provider Number
180050
Participating Start Date
4/1/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #18059
100 HOLLY HILLS MALL RD
HINDMAN, KY 41822
Pharmacy Comments
Contract Details
Approval Date
10/10/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
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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