Contract Pharmacy Details

WALGREEN CO.
DSH510055 Cabell Huntington Hospital, Inc.

Covered Entity Details

Entity Name

Cabell Huntington Hospital, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH510055

Entity Address

1340 Hal Greer Blvd.
Huntington, WV 25701-0195

Medicare Provider Number

510055

Participating Start Date

4/1/2005

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #17704
10295 ROUTE 152
WAYNE, WV 25570-5810

Pharmacy Comments

Contract Details

Approval Date

4/5/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/18/2025
Pharmacy closed

Contacts

Covered Entity Signing Official

David M Ward, Sr. Vp/Cfo
(304) 526-2055

Contract Pharmacy Representative

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

Signed By Date

4/5/2021

340B Drug Pricing Program Database