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WALGREEN CO.
DSH150015 FRANCISCAN HEALTH MICHIGAN CITY
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Covered Entity Details
Entity Name
FRANCISCAN HEALTH MICHIGAN CITY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150015
Entity Address
3500 FRANCISCAN WAY
MICHIGAN CITY, IN 46360
Medicare Provider Number
150015
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #13949
6001 CENTRAL AVE
PORTAGE, IN 46368-3506
Pharmacy Comments
09/27/2012 Pharmacy moved (was #2765 6030 CENTRAL)
Contract Details
Approval Date
10/25/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Trish L. Weber, VP Operations/CNO
(219) 877-1766
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/12/2018
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