340B Drug Pricing Program Database
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WALGREEN CO.
DSH150074 Community Health Network, Inc.
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Covered Entity Details
Entity Name
Community Health Network, Inc.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150074
Entity Address
1500 N. RITTER AVE.
INDIANAPOLIS, IN 46219
Medicare Provider Number
150074
Participating Start Date
4/1/2008
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS #16558
1400 N RITTER AVE.
SUITE 140
INDIANAPOLIS, IN 46219
Pharmacy Comments
Contract Details
Approval Date
7/13/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott L. Teffeteller, President, East Region
(317) 355-3390
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/13/2018
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