Contract Pharmacy Details

WALGREEN CO.
DSH180005 HIGHLANDS ARH REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

HIGHLANDS ARH REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180005

Entity Address

5000 KY RT 321
PRESTONSBURG, KY 41653

Medicare Provider Number

180005

Participating Start Date

9/9/2005

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05001
2490 BARDSTOWN RD.
LOUISVILLE, KY 40205

Pharmacy Comments

Contract Details

Approval Date

7/10/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Maria Braman, Chief Medical Officer
(406) 465-8506

Contract Pharmacy Representative

Walgreens
Allene Stewart, Analyst, 340B Client Relationship
(847) 315-4442

Signed By Date

7/10/2023

340B Drug Pricing Program Database