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WALGREEN CO.
DSH150074 Community Health Network, Inc.
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Covered Entity Details
Entity Name
Community Health Network, Inc.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150074
Entity Address
1500 N. RITTER AVE.
INDIANAPOLIS, IN 46219
Medicare Provider Number
150074
Participating Start Date
4/1/2008
Last Recertification Date
8/12/2024
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
4/12/2019
Contract Begin Date
7/1/2019
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
David Kiley, President
(317) 621-9337
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2019
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