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WALGREEN CO.
DSH150007 COMMUNITY HOWARD REGIONAL HEALTH
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Covered Entity Details
Entity Name
COMMUNITY HOWARD REGIONAL HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150007
Entity Address
3500 SOUTH LAFOUNTAIN
KOKOMO, IN 46902
Medicare Provider Number
150007
Participating Start Date
1/1/2016
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #16557
1550 E. COUNTY LINE ROAD
SUITE 150
INDIANAPOLIS, IN 46227
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/3/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joseph Hooper, President & CEO
(765) 776-8580
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2018
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