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WALGREEN CO.
CAH511318-00 Montgomery General Hospital, Inc
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Covered Entity Details
Entity Name
Montgomery General Hospital, Inc
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511318-00
Entity Address
401 Sixth Avenue
Montgomery, WV 25136
Medicare Provider Number
511318
Participating Start Date
7/1/2012
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17781
2100 E DUPONT AVE
BELLE, WV 25015-1348
Pharmacy Comments
Contract Details
Approval Date
4/13/2018
Contract Begin Date
5/9/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/6/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Sherri Murray, CFO
(304) 442-1246
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/13/2018
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