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WALGREEN CO.
DSH510008 City Hospital, Inc. DBA Berkeley Medical Center
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Covered Entity Details
Entity Name
City Hospital, Inc. DBA Berkeley Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510008
Entity Address
2500 HOSPITAL DRIVE
MARTINSBURG, WV 25401
Medicare Provider Number
510008
Participating Start Date
10/1/2007
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #15978
324 E. ANTIETAM STREET
SUITE 202
HAGERSTOWN, MD 21740
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Grover Glendon Kerns, VP of Finance
(304) 260-1443
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2024
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