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WALGREEN CO.
CAH181310-00 CARROLL COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CARROLL COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181310-00
Entity Address
309 11TH STREET
CARROLLTON, KY 41008
Medicare Provider Number
181310
Participating Start Date
10/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17241
204 PARK AVE
CARROLLTON, KY 41008
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/20/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Harry Hays, CEO
(502) 732-3200
Contract Pharmacy Representative
Carroll Co. Hospital
Larry L Abplanalp, Director Pharmacy
(812) 599-2859
Signed By Date
4/16/2018
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