Contract Pharmacy Details

WALGREEN CO.
DSH520096 Ascension All Saints Hospital, Inc.

Covered Entity Details

Entity Name

Ascension All Saints Hospital, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH520096

Entity Address

3801 SPRING STREET
RACINE, WI 53405

Medicare Provider Number

520096

Participating Start Date

4/1/2004

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS SPECIALTY PHARMACY #21254
2265 N MAYFAIR RD.
WAUWATOSA, WI 53226

Pharmacy Comments

Contract Details

Approval Date

1/10/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Vanessa Freitag, Vice President, Pharmacy
(715) 897-1183

Contract Pharmacy Representative

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

Signed By Date

1/10/2020

340B Drug Pricing Program Database