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WALGREEN CO
DSH180093 Baptist Health Deaconess Madisonville
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Covered Entity Details
Entity Name
Baptist Health Deaconess Madisonville
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180093
Entity Address
900 HOSPITAL DRIVE
MADISONVILLE, KY 42431
Medicare Provider Number
180093
Participating Start Date
1/1/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #11394
1801 N MAIN ST
MADISONVILLE, KY 42431
Pharmacy Comments
Contract Details
Approval Date
6/1/2023
Contract Begin Date
6/6/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/5/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kim Ashby, Vice President of Finance
(270) 825-5781
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/1/2023
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