Contract Pharmacy Details

WALGREEN CO.
CAH511308-00 BRAXTON COUNTY MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

BRAXTON COUNTY MEMORIAL HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH511308-00

Entity Address

100 HOYLMAN DRIVE
GASSAWAY, WV 26624-9320

Medicare Provider Number

511308

Participating Start Date

9/21/2010

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #18398
27 W MAIN ST.
SUTTON, WV 26601-1025

Pharmacy Comments

Contract Details

Approval Date

2/21/2018

Contract Begin Date

2/21/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/16/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

BEN VINCENT, CEO
(304) 364-1127

Contract Pharmacy Representative

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

Signed By Date

2/21/2018

340B Drug Pricing Program Database