340B Drug Pricing Program Database
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WALGREEN CO.
DSH510013 REYNOLDS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
REYNOLDS MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510013
Entity Address
800 WHEELING AVENUE
GLEN DALE, WV 26038
Medicare Provider Number
510013
Participating Start Date
7/1/2021
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17949
120 JEFFERSON AVE
MOUNDSVILLE, WV 26041-1411
Pharmacy Comments
Contract Details
Approval Date
1/18/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alex Craig Inclan, CFO
(304) 843-3240
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/18/2022
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