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WALGREEN CO.
RRC140223-00 ADVOCATE LUTHERAN GENERAL HOSPITAL
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Covered Entity Details
Entity Name
ADVOCATE LUTHERAN GENERAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC140223-00
Entity Address
1775 W. DEMPSTER STREET
PARK RIDGE, IL 60068
Medicare Provider Number
140223
Participating Start Date
4/1/2019
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 00039
235 E PALATINE RD
ARLINGTON HEIGHTS, IL 60004
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nanine Nelson, SVP-Finance
(414) 299-1610
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2019
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