340B Drug Pricing Program Database
WALGREEN CO.
DSH260091 SSM HEALTH ST MARY'S HOSPITAL-STL - information as of 4/30/2025 11:24:22 PM
Covered Entity Details
Entity Name
SSM HEALTH ST MARY'S HOSPITAL-STL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260091
Entity Address
6420 CLAYTON ROAD
ST. LOUIS, MO 63117
Medicare Provider Number
260091
Participating Start Date
10/1/2006
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05667
6071 TELEGRAPH ROAD
ST LOUIS, MO 63129
Pharmacy Comments
Contract Details
Approval Date
4/19/2019
Contract Begin Date
4/19/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen D. Rewerts, Regional VP of Financa/CFO
(314) 989-2034
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/19/2019
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