Contract Pharmacy Details

WALGREEN CO.
CAH181314-00 The Medical Center at Caverna

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

WALGREENS #17438
394 N DIXIE ST
HORSE CAVE, KY 42749

Pharmacy Comments

Contract Details

Approval Date

10/17/2022

Contract Begin Date

1/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/24/2025
Pharmacy closed

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

340B Drug Pricing Program Database