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WALGREEN CO
DSH180080 BAPTIST HEALTH CORBIN
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Covered Entity Details
Entity Name
BAPTIST HEALTH CORBIN
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180080
Entity Address
1 TRILLIUM WAY
CORBIN, KY 40701
Medicare Provider Number
180080
Participating Start Date
10/1/2004
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #12152
1775 HIGHWAY 192 W
LONDON, KY 40741
Pharmacy Comments
Contract Details
Approval Date
7/14/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anthony Powers, COO
(606) 523-8626
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2023
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