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Walgreens #21423
DSH180043 AdventHealth Manchester
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Covered Entity Details
Entity Name
AdventHealth Manchester
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180043
Entity Address
210 MARIE LANGDON DRIVE
MANCHESTER, KY 40962
Medicare Provider Number
180043
Participating Start Date
10/1/2017
Last Recertification Date
9/5/2024
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
10/11/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jesse Kleven, VP/CFO AdventHealth Manchester
(606) 598-1035
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2023
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