Contract Pharmacy Details

WALGREEN CO.
DSH510022 CHARLESTON AREA MEDICAL CENTER (CAMC)

Covered Entity Details

Entity Name

CHARLESTON AREA MEDICAL CENTER (CAMC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH510022

Entity Address

501 MORRIS STREET
CHARLESTON, WV 25301

Medicare Provider Number

510022

Participating Start Date

9/22/2005

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

RITE AID #03702
932 CROSS LANES DR
CROSS LANES, WV 25313

Pharmacy Comments

Contract Details

Approval Date

4/11/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/8/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

STEPHEN BELL, VICE PRESIDENT - FINANCE
(304) 388-6251

Contract Pharmacy Representative

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

Signed By Date

4/11/2018

340B Drug Pricing Program Database