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WALGREEN CO.
DSH180067 UNIVERSITY OF KENTUCKY
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Covered Entity Details
Entity Name
UNIVERSITY OF KENTUCKY
Subdivision Name
UK Chandler Hospital
Type
Disproportionate Share Hospital
340B ID
DSH180067
Entity Address
800 ROSE STREET
LEXINGTON, KY 40536
Medicare Provider Number
180067
Participating Start Date
12/1/1992
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17138
104 PEDRO WAY
WINCHESTER, KY 40391
Pharmacy Comments
Contract Details
Approval Date
2/2/2018
Contract Begin Date
2/5/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/21/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Robert Cofield, VP & Chief Clinical Operations Officer
(859) 257-4368
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
2/2/2018
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