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WALGREENS SPECIALTY PHARMACY, LLC
CAH511308-00 BRAXTON COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BRAXTON COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511308-00
Entity Address
100 HOYLMAN DRIVE
GASSAWAY, WV 26624-9320
Medicare Provider Number
511308
Participating Start Date
9/21/2010
Last Recertification Date
8/15/2024
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
1/12/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/15/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
BEN VINCENT, CEO
(304) 364-1127
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/12/2018
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