340B Drug Pricing Program Database
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WALGREEN CO.
DSH180079 HARRISON MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
HARRISON MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180079
Entity Address
1210 KY HIGHWAY 36 E
CYNTHIANA, KY 41031
Medicare Provider Number
180079
Participating Start Date
9/9/2005
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #21170
393 WALLER AVE STE 5
LEXINGTON, KY 40504
Pharmacy Comments
Contract Details
Approval Date
1/5/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen Toadvine, Chief Executive Officer
(859) 235-3503
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/5/2023
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