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WALGREEN CO.
CAH181321-00 Wayne County Hospital, Inc.
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Covered Entity Details
Entity Name
Wayne County Hospital, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181321-00
Entity Address
166 Hospital Street
Monticello, KY 42633
Medicare Provider Number
181321
Participating Start Date
4/1/2012
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17172
978 N MAIN ST
MONTICELLO, KY 42633
Pharmacy Comments
Contract Details
Approval Date
4/12/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anne Sawyer, CFO
(606) 348-9343
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2018
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