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Walgreens #21420
CAH511311-00 HAMPSHIRE MEMORIAL HOSPITAL, INC.
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Covered Entity Details
Entity Name
HAMPSHIRE MEMORIAL HOSPITAL, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511311-00
Entity Address
363 Sunrise Boulevard
ROMNEY, WV 26757
Medicare Provider Number
511311
Participating Start Date
9/13/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
Walgreens #21420
Pharmacy Address
Walgreens Central Fill #21420
8440 Times Dispatch Blvd
Ste. 400
Mechanicsville, VA 23116
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Amos, CFO, Valley Health System
(540) 536-8031
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/17/2023
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