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Walgreens #21423
CAH511300-00 Broaddus Hospital Association, Inc. DBA Broaddus Hospital
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Covered Entity Details
Entity Name
Broaddus Hospital Association, Inc. DBA Broaddus Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511300-00
Entity Address
# 1 HEALTHCARE DRIVE
PHILIPPI, WV 26416
Medicare Provider Number
511300
Participating Start Date
10/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
Walgreens #21423
Pharmacy Address
Walgreens Central Fill #21423
6275 Winchester Blvd
Canal WInchester, OH 43110-6537
Pharmacy Comments
Contract Details
Approval Date
10/5/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DANA GOULD, CEO
(304) 457-8155
Contract Pharmacy Representative
Walgreen Co.
Enrique Anza, Sr. Analyst, 340B Client Relationship
(847) 964-6160
Signed By Date
10/5/2023
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