Contract Pharmacy Details

WALGREEN CO.
FQHCLA128 HYGEIA FACILITIES FOUNDATION, INC.

Covered Entity Details

Entity Name

HYGEIA FACILITIES FOUNDATION, INC.

Subdivision Name

RALEIGH BOONE MEDICAL CENTER

Type

Health Center Program Look-Alike

340B ID

FQHCLA128

Entity Address

37456 COAL RIVER ROAD
WHITESVILLE, WV 25209

Grant Number

LALCS00039

Participating Start Date

4/1/2004

Last Recertification Date

2/27/2023

Entity Termination Date

7/1/2023

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #17559
69 LEWIS ST.
WHITESVILLE, WV 25209

Pharmacy Comments

Contract Details

Approval Date

2/20/2018

Contract Begin Date

2/21/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Margaret L. Martin, Executive Director
(304) 854-1323

Contract Pharmacy Representative

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

Signed By Date

2/20/2018

340B Drug Pricing Program Database