Contract Pharmacy Details

WALGREEN CO.
DSH510007 ST. MARYS MEDICAL CENTER INC.

Covered Entity Details

Entity Name

ST. MARYS MEDICAL CENTER INC.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH510007

Entity Address

2900 FIRST AVENUE
HUNTINGTON, WV 25702-1241

Medicare Provider Number

510007

Participating Start Date

7/1/2016

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #17782
8315 COURT AVE
HAMLIN, WV 25523-1332

Pharmacy Comments

Contract Details

Approval Date

4/7/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/16/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Angela Swearingen, VP Finance/CFO
(304) 526-1224

Contract Pharmacy Representative

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

Signed By Date

4/7/2021

340B Drug Pricing Program Database