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WALGREEN CO.
CAH181309-00 CASEY COUNTY HOSPITAL DISTRICT D/B/A CASEY COUNTY HOSPITAL
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Covered Entity Details
Entity Name
CASEY COUNTY HOSPITAL DISTRICT D/B/A CASEY COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181309-00
Entity Address
187 WOLFORD AVENUE
LIBERTY, KY 42539
Medicare Provider Number
181309
Participating Start Date
7/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #19533
343 N WALLACE WILKINSON BLVD
LIBERTY, KY 42539
Pharmacy Comments
Contract Details
Approval Date
2/12/2018
Contract Begin Date
2/13/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/4/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
REX A. TUNGATE, CEO
(606) 787-6275 Ext: 601
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
2/12/2018
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