Contract Pharmacy Details

WALGREEN CO.
DSH360137 UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH360137

Entity Address

11100 EUCLID AVE.
CLEVELAND, OH 44106

Medicare Provider Number

360137

Participating Start Date

7/1/2004

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #21259
14501 EUCLID AVE
EAST CLEVELAND, OH 44112-3426

Pharmacy Comments

Contract Details

Approval Date

1/9/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/31/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Michael R. Vehovec, Corporate Controller
(216) 767-8729

Contract Pharmacy Representative

Walgreens
Betsy Mileski, Regional Director
(757) 206-7446

Signed By Date

1/9/2020

340B Drug Pricing Program Database