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WALGREEN CO.
CAH181314-00 The Medical Center at Caverna
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Covered Entity Details
Entity Name
The Medical Center at Caverna
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181314-00
Entity Address
1501 South Dixie Street
Horse Cave, KY 42749
Medicare Provider Number
181314
Participating Start Date
10/1/2011
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07712
1001 W MAIN STREET
GLASGOW, KY 42141-1119
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Wade R. Stone, Executive Vice President
(270) 745-1504
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/17/2022
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