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WALGREEN CO.
CAH181325-00 JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC. D/B/A JANE TODD CRAWFORD HOSPITAL
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Covered Entity Details
Entity Name
JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC. D/B/A JANE TODD CRAWFORD HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181325-00
Entity Address
290 Industrial Park Road
GREENSBURG, KY 42743
Medicare Provider Number
181325
Participating Start Date
7/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #19855
603 COLUMBIA HWY
GREENSBURG, KY 42743
Pharmacy Comments
Contract Details
Approval Date
3/5/2018
Contract Begin Date
3/7/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/4/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
REX A. TUNGATE, CEO
(270) 932-9696 Ext: 22
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
3/5/2018
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