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WALGREEN CO.
CAH511315-00 POTOMAC VALLEY HOSPITAL
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Covered Entity Details
Entity Name
POTOMAC VALLEY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511315-00
Entity Address
100 PIN OAK LANE
KEYSER, WV 26726
Medicare Provider Number
511315
Participating Start Date
4/1/2016
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #19956
839 S MINERAL ST
KEYSER, WV 26726
Pharmacy Comments
Contract Details
Approval Date
1/18/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/21/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Justin Gibson, VP of Finance-North Region
(304) 598-4256
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/18/2022
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