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WALGREEN CO.
DSH510038 STONEWALL JACKSON MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
STONEWALL JACKSON MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510038
Entity Address
230 Hospital Plaza
WESTON, WV 26452
Medicare Provider Number
510038
Participating Start Date
1/1/2019
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #18398
27 W MAIN ST.
SUTTON, WV 26601-1025
Pharmacy Comments
Contract Details
Approval Date
3/1/2018
Contract Begin Date
3/2/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Joe Barnes, Chief Financial Officer
(304) 269-8050
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
3/1/2018
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