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WALGREEN CO.
RRC150015-00 FRANCISCAN HEALTH MICHIGAN CITY
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Covered Entity Details
Entity Name
FRANCISCAN HEALTH MICHIGAN CITY
Subdivision Name
Type
Rural Referral Center
340B ID
RRC150015-00
Entity Address
3500 Franciscan Way
MICHIGAN CITY, IN 46360
Medicare Provider Number
150015
Participating Start Date
10/1/2019
Last Recertification Date
8/22/2023
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 12074
308 NORTH MAIN STREET
HEBRON, IN 46341
Pharmacy Comments
Contract Details
Approval Date
9/5/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Trish L. Weber, VP Operations/CNO
(219) 877-1766
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/12/2019
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