Contract Pharmacy Details

WALGREEN CO.
RRC360239-00 Kettering Health Miamisburg

Covered Entity Details

Entity Name

Kettering Health Miamisburg

Subdivision Name

Type

Rural Referral Center

340B ID

RRC360239-00

Entity Address

4000 Miamisburg-Centerville Rd
MIAMISBURG, OH 45342

Medicare Provider Number

360239

Participating Start Date

4/1/2021

Last Recertification Date

8/14/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 04520
1260 E CENTRAL
MIAMISBURG, OH 45342

Pharmacy Comments

Contract Details

Approval Date

1/6/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/31/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

William E Villegas, Regional VP of Finance
(937) 723-3414

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/5/2021

340B Drug Pricing Program Database