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WALGREEN CO.
DSH510006 UNITED HOSPITAL CENTER
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Covered Entity Details
Entity Name
UNITED HOSPITAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510006
Entity Address
327 MEDICAL PARK DRIVE
BRIDGEPORT, WV 26330
Medicare Provider Number
510006
Participating Start Date
10/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #19852
505 ROSEBUD PLZ
CLARKSBURG, WV 26301-9380
Pharmacy Comments
Contract Details
Approval Date
10/11/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/28/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
James Rutkowski, VP Finance/CFO
(681) 342-1605
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2022
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