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WALGREEN CO.
RRC260175-00 GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
Subdivision Name
Type
Rural Referral Center
340B ID
RRC260175-00
Entity Address
1600 NORTH SECOND STREET
CLINTON, MO 64735
Medicare Provider Number
260175
Participating Start Date
9/29/2010
Last Recertification Date
8/31/2020
Entity Termination Date
10/1/2021
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09382
412 PAWNEE STREET
CLINTON, MO 64735-2481
Pharmacy Comments
Contract Details
Approval Date
4/5/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Lynnette Hayes, CNO
(660) 890-7167
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/5/2017
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