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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11981
5870 WEBSTER RD.
SUMMERSVILLE, WV 26651
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
11/6/2023
Pharmacy closed
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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