Contract Pharmacy Details

WALGREEN CO.
DSH180044 PIKEVILLE MEDICAL CENTER, INC.

Covered Entity Details

Entity Name

PIKEVILLE MEDICAL CENTER, INC.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180044

Entity Address

911 BYPASS ROAD
PIKEVILLE, KY 41501

Medicare Provider Number

180044

Participating Start Date

1/1/2007

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #17504
164 HOLDEN RD
MOUNT GAY, WV 25637

Pharmacy Comments

Contract Details

Approval Date

7/15/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

MICHELLE HAGY, CFO
(606) 430-3519

Contract Pharmacy Representative

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

Signed By Date

7/15/2021

340B Drug Pricing Program Database