Contract Pharmacy Details

WALGREEN CO.
DSH180017 TJ SAMSON COMMUNITY HOSPITAL

Covered Entity Details

Entity Name

TJ SAMSON COMMUNITY HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180017

Entity Address

1301 NORTH RACE STREET
GLASGOW, KY 42141

Medicare Provider Number

180017

Participating Start Date

7/1/2005

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 07712
1001 W MAIN STREET
GLASGOW, KY 42141-1119

Pharmacy Comments

Contract Details

Approval Date

7/5/2013

Contract Begin Date

10/1/2013

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

BILL KINDRED, CEO
(270) 651-4159

Contract Pharmacy Representative

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

Signed By Date

7/5/2013

340B Drug Pricing Program Database