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WALGREEN CO.
DSH180044C PIKEVILLE MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
PIKEVILLE MEDICAL CENTER, INC.
Subdivision Name
PIKEVILLE SLEEP LAB
Type
Disproportionate Share Hospital
340B ID
DSH180044C
Entity Address
911 Bypass Road
Building A
PIKEVILLE, KY 41501
Medicare Provider Number
180044
Outpatient Facility Provider Number
Participating Start Date
10/1/2017
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17546
101 LAUREL AVE
PO BOX 2043
COEBURN, VA 24230-2043
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2022
Agreement registered in error
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
10/15/2021
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