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WALGREEN CO.
DSH180009 KING'S DAUGHTERS MEDICAL CENTER
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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 #19356
933 BLACKBURN AVE
ASHLAND, KY 41101
Pharmacy Comments
Contract Details
Approval Date
3/2/2018
Contract Begin Date
3/2/2018
Carve-In Effective Date
Contract Comments
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
3/2/2018
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