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WALGREEN CO.
DSH180043 AdventHealth Manchester
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Covered Entity Details
Entity Name
AdventHealth Manchester
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180043
Entity Address
210 MARIE LANGDON DRIVE
MANCHESTER, KY 40962
Medicare Provider Number
180043
Participating Start Date
10/1/2017
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #19658
560 MANCHESTER SQUARE SHPG CTR
MANCHESTER, KY 40962
Pharmacy Comments
Contract Details
Approval Date
1/31/2018
Contract Begin Date
2/14/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/26/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
STEVEN MILLER, VP FINANCE/CFO
(606) 598-1035
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/31/2018
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