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Walgreens #21423
DSH510013 REYNOLDS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
REYNOLDS MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510013
Entity Address
800 WHEELING AVENUE
GLEN DALE, WV 26038
Medicare Provider Number
510013
Participating Start Date
7/1/2021
Last Recertification Date
8/13/2024
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
7/16/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alex Craig Inclan, CFO
(304) 843-3240
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/16/2024
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