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WALGREEN CO.
DSH140304 UChicago Medicine AdventHealth Bolingbrook
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Covered Entity Details
Entity Name
UChicago Medicine AdventHealth Bolingbrook
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140304
Entity Address
500 REMINGTON BLVD.
BOLINGBROOK, IL 60440-4988
Medicare Provider Number
140304
Participating Start Date
10/1/2009
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03710
15575 E 127TH STREET
LEMONT, IL 60439
Pharmacy Comments
Contract Details
Approval Date
10/16/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/29/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Vladimir Radivojevic, President & CEO
(630) 545-7258
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2019
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