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WALGREENS SPECIALTY PHARMACY, LLC
CAH511313-00 BOONE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BOONE MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511313-00
Entity Address
701 Madison Avenue
MADISON, WV 25130
Medicare Provider Number
511313
Participating Start Date
1/1/2011
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
ALLIANCERX WALGREENS PRIME #12314
9775 SW GEMINI DR, STE 1
BEAVERTON, OR 97008
Pharmacy Comments
Contract Details
Approval Date
1/10/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
RANDELL Davis FOXX, CFO
(304) 369-1230 Ext: 5508
Contract Pharmacy Representative
Walgreens
Karl Neehan, VP, Health Systems Programs
(847) 315-2663
Signed By Date
1/10/2018
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