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WALGREEN CO.
CAH151332-00 DECATUR COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
DECATUR COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151332-00
Entity Address
720 NORTH LINCOLN STREET
GREENSBURG, IN 47240
Medicare Provider Number
151332
Participating Start Date
8/18/2010
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09489
1010 EAST STATE RD 44
SHELBYVILLE, IN 46176-1770
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/15/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Rex McKinney, CEO
(812) 663-1171
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/17/2018
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