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WALGREEN CO.
CH034050 BLUE RIDGE MEDICAL CENTER INC
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Covered Entity Details
Entity Name
BLUE RIDGE MEDICAL CENTER INC
Subdivision Name
BLUE RIDGE MEDICAL CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH034050
Entity Address
4038 Thomas Nelson Hwy
Arrington, VA 22922-2302
Grant Number
H80CS00175
Participating Start Date
12/1/1992
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17477
74 TANBARK PLZ
P.O. BOX 318
LOVINGSTON, VA 22949-2464
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Randolph Pirtle, CEO
(434) 263-4000
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2020
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