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WALGREEN CO.
DSH180002 WHITESBURG ARH HOSPITAL
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Covered Entity Details
Entity Name
WHITESBURG ARH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180002
Entity Address
240 HOSPITAL ROAD
WHITESBURG, KY 41858
Medicare Provider Number
180002
Participating Start Date
4/1/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #19026
426 VILLAGE LN
HAZARD, KY 41701
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
9/30/2024
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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