Contract Pharmacy Details

WALGREEN CO
DSH150065 SCHNECK MEDICAL CENTER

Covered Entity Details

Entity Name

SCHNECK MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH150065

Entity Address

411 WEST TIPTON STREET
SEYMOUR, IN 47274

Medicare Provider Number

150065

Participating Start Date

10/1/2016

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA: WALGREENS #11454
319 E TIPTON STREET
SEYMOUR, IN 47274

Pharmacy Comments

Contract Details

Approval Date

7/17/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Deborah Ridlen, VP Finance/CFO
(812) 522-0170

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/17/2018

340B Drug Pricing Program Database