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WALGREEN CO.
CH040600 MOUNTAIN COMPREHENSIVE HEALTH CORP., INC.
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Covered Entity Details
Entity Name
MOUNTAIN COMPREHENSIVE HEALTH CORP., INC.
Subdivision Name
Whitesburg Medical/Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH040600
Entity Address
226 Medical Plaza Ln
Whitesburg, KY 41858-7425
Grant Number
H80CS00367
Participating Start Date
10/1/2004
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11435
915 N. BROAD ST.
NEW TAZEWELL, TN 37825-6633
Pharmacy Comments
Contract Details
Approval Date
1/19/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
L.M. Caudill, CEO
(606) 633-4823
Contract Pharmacy Representative
Walgreens
Lisa Villarreal, Analyst, 340B Operations
(847) 964-6183
Signed By Date
1/19/2022
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