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WALGREEN CO.
DSH490052 RIVERSIDE REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
RIVERSIDE REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490052
Entity Address
500 J Clyde Morris Blvd
NEWPORT NEWS, VA 23601
Medicare Provider Number
490052
Participating Start Date
7/1/2008
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04446
3965 HOLLAND RD.
VIRGINIA BEACH, VA 23452
Pharmacy Comments
Contract Details
Approval Date
11/25/2011
Contract Begin Date
11/25/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/19/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Wade Broughman, EVP
(757) 534-7035
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
11/30/2011
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