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WALGREEN CO.
DSH510012 PLEASANT VALLEY HOSPITAL
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Covered Entity Details
Entity Name
PLEASANT VALLEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510012
Entity Address
2520 VALLEY DRIVE
POINT PLEASANT, WV 25550
Medicare Provider Number
510012
Participating Start Date
7/1/2006
Last Recertification Date
8/14/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17116
635 MAIN ST W
RIPLEY, WV 25271-1107
Pharmacy Comments
Contract Details
Approval Date
7/5/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Craig Gilliland, Chief Financial Officer
(304) 675-4340 Ext: 1398
Contract Pharmacy Representative
Walgreen
Jaqueline Ochoa, Client Relationshions
(217) 709-2297
Signed By Date
7/5/2022
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