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WALGREEN CO.
DSH140052 OSF SAINT ANTHONY'S HEALTH CENTER
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Covered Entity Details
Entity Name
OSF SAINT ANTHONY'S HEALTH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140052
Entity Address
1 SAINT ANTHONYS WAY
ALTON, IL 62002
Medicare Provider Number
140052
Participating Start Date
3/15/2022
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03714
2610 STATE ST
ALTON, IL 62002-5150
Pharmacy Comments
Contract Details
Approval Date
3/1/2019
Contract Begin Date
3/15/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Diane L. McGrew, President
(309) 655-2850
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
3/1/2019
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