340B Drug Pricing Program Database
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WALGREEN CO.
DSH490053 JOHNSTON MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
JOHNSTON MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490053
Entity Address
16000 JOHNSTON MEMORIAL DRIVE
ABINGDON, VA 24211
Medicare Provider Number
490053
Participating Start Date
10/30/2020
Last Recertification Date
9/11/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #09948
668 W. MAIN ST.
ABINGDON, VA 24210-2510
Pharmacy Comments
Contract Details
Approval Date
1/14/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Shane Hilton, EVP, Chief Financial Officer
(423) 302-3467
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2022
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