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WALGREEN CO.
CAH511301-00 WEBSTER MEMORIAL HOSPITAL, INC.
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Covered Entity Details
Entity Name
WEBSTER MEMORIAL HOSPITAL, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511301-00
Entity Address
125 Diana Drive
WEBSTER SPRINGS, WV 26288
Medicare Provider Number
511301
Participating Start Date
4/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11981
5870 WEBSTER RD.
SUMMERSVILLE, WV 26651
Pharmacy Comments
Contract Details
Approval Date
1/19/2018
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
JULIE CLUTTER, DIRECTOR FINANCIAL SERVICES
(304) 847-5682 Ext: 3100
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/19/2018
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