Contract Pharmacy Details

WALGREEN CO.
DSH180005 HIGHLANDS ARH REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

HIGHLANDS ARH REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180005

Entity Address

5000 KY RT 321
PRESTONSBURG, KY 41653

Medicare Provider Number

180005

Participating Start Date

9/9/2005

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #17164
103 GLYNNVIEW PLZ
PRESTONSBURG, KY 41653

Pharmacy Comments

Contract Details

Approval Date

2/19/2018

Contract Begin Date

2/21/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/21/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Harold C. Warman Jr., CEO
(606) 886-7602

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

2/19/2018

340B Drug Pricing Program Database