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WALGREEN CO.
DSH140088 THE UNIVERSITY OF CHICAGO MEDICAL CENTER
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Covered Entity Details
Entity Name
THE UNIVERSITY OF CHICAGO MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140088
Entity Address
5841 S. MARYLAND AVE.
CHICAGO, IL 60637
Medicare Provider Number
140088
Participating Start Date
10/1/2003
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 00178
740 W DIVERSEY PKWY
CHICAGO, IL 60614
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard Walter Silveria, EVP and CFO
(773) 834-2802
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2019
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