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WALGREENS SPECIALTY PHARMACY, LLC
CAH511307-00 GRAFTON CITY HOSPITAL
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Covered Entity Details
Entity Name
GRAFTON CITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511307-00
Entity Address
1 Hospital Plaza
GRAFTON, WV 26354
Medicare Provider Number
511307
Participating Start Date
7/1/2011
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
1/10/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patrick D. Shaw, CEO
(304) 265-7152
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/10/2018
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