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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
RITE AID #04641
408 OLDHAM PLZ
LA GRANGE, KY 40031
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
3/1/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Harry Hays, CEO
(502) 732-3200
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2018
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