Contract Pharmacy Details

WALGREEN CO.
DSH180029 HAZARD ARH REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

HAZARD ARH REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180029

Entity Address

100 MEDICAL CENTER DRIVE
HAZARD, KY 41701

Medicare Provider Number

180029

Participating Start Date

10/1/2004

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #18275
28 MAIN AVE
PO BOX 4547
LOGAN, WV 25601-3331

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

340B Drug Pricing Program Database