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WALGREEN CO.
CAH511322-00 West Virginia Health Care Cooperative, Inc. DBA Summersville Regional Medical Center
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Covered Entity Details
Entity Name
West Virginia Health Care Cooperative, Inc. DBA Summersville Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511322-00
Entity Address
400 FAIRVIEW HEIGHTS ROAD
SUMMERSVILLE, WV 26651
Medicare Provider Number
511322
Participating Start Date
7/1/2019
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11981
5870 WEBSTER RD.
SUMMERSVILLE, WV 26651
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
11/6/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
John Timothy Lewis, COO
(304) 872-2891
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/18/2022
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