Contract Pharmacy Details

WALGREEN CO.
DSH180009 KING'S DAUGHTERS MEDICAL CENTER

Covered Entity Details

Entity Name

KING'S DAUGHTERS MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180009

Entity Address

2201 LEXINGTON AVENUE
ASHLAND, KY 41101

Medicare Provider Number

180009

Participating Start Date

4/1/2006

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #19751
410 W TOM T HALL BLVD
OLIVE HILL, KY 41164

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

2/20/2025
Pharmacy closed

Contacts

Covered Entity Signing Official

Kristie Whitlatch, CEO
(606) 408-4401

Contract Pharmacy Representative

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

Signed By Date

3/1/2018

340B Drug Pricing Program Database