Contract Pharmacy Details

WALGREEN CO.
DSH180088 NORTON HOSPITALS, INC

Covered Entity Details

Entity Name

NORTON HOSPITALS, INC

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH180088

Entity Address

200 East Chestnut Street
LOUISVILLE, KY 40202

Medicare Provider Number

180088

Participating Start Date

1/1/2004

Last Recertification Date

8/27/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS #17942
9616 COUNTY ROAD 403
CHARLESTOWN, IN 47111

Pharmacy Comments

Contract Details

Approval Date

8/7/2019

Contract Begin Date

8/7/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Adam David Kempf, CFO
(502) 420-2255

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

8/7/2019

340B Drug Pricing Program Database