Contract Pharmacy Details

WALGREEN CO.
CAH511301-00 WEBSTER MEMORIAL HOSPITAL, INC.

Covered Entity Details

Entity Name

WEBSTER MEMORIAL HOSPITAL, INC.

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH511301-00

Entity Address

125 Diana Drive
WEBSTER SPRINGS, WV 26288

Medicare Provider Number

511301

Participating Start Date

4/1/2011

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

RITE AID #01687
306 N MAIN ST
WEBSTER SPRINGS, WV 26288

Pharmacy Comments

Contract Details

Approval Date

3/2/2018

Contract Begin Date

3/5/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/17/2020
Pharmacy closed

Contacts

Covered Entity Signing Official

JULIE CLUTTER, DIRECTOR FINANCIAL SERVICES
(304) 847-5682 Ext: 3100

Contract Pharmacy Representative

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

Signed By Date

3/2/2018

340B Drug Pricing Program Database