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WALGREEN CO.
DSH510001 WEST VIRGINIA UNIVERSITY HOSPITALS, INC.
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Covered Entity Details
Entity Name
WEST VIRGINIA UNIVERSITY HOSPITALS, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510001
Entity Address
1 MEDICAL CENTER DRIVE
MORGANTOWN, WV 26506
Medicare Provider Number
510001
Participating Start Date
7/1/2002
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: MY PHARMACY
781 CHESTNUT RIDGE ROAD
MORGANTOWN, WV 26505
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
5/12/2022
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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