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WALGREEN CO.
CAH491302-00 CARILION GILES COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
CARILION GILES COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH491302-00
Entity Address
159 HARTLEY WAY
PEARISBURG, VA 24134
Medicare Provider Number
491302
Participating Start Date
8/30/2010
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11972
240 BROAD ST.
DUBLIN, VA 24084
Pharmacy Comments
Contract Details
Approval Date
10/17/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/14/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
William Flattery, VP Community Hospital, Administration
(540) 598-1933
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/17/2019
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