Contract Pharmacy Details

WALGREEN CO.
DSH180070 Owensboro Health Twin Lakes Regional Medical Center, Inc

Covered Entity Details

Entity Name

Owensboro Health Twin Lakes Regional Medical Center, Inc

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180070

Entity Address

910 WALLACE AVENUE
LEITCHFIELD, KY 42754

Medicare Provider Number

180070

Participating Start Date

4/1/2006

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #17497
1006 MAIN ST
MUNFORDVILLE, KY 42765

Pharmacy Comments

Contract Details

Approval Date

10/14/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/11/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Ashley Herrington, CEO
(270) 259-9510

Contract Pharmacy Representative

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

Signed By Date

10/14/2021

340B Drug Pricing Program Database