Contract Pharmacy Details

WALGREEN CO.
DSH140239 Javon Bea Hospital

Covered Entity Details

Entity Name

Javon Bea Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140239

Entity Address

8201 E Riverside Blvd
Rockford, IL 61114

Medicare Provider Number

140239

Participating Start Date

1/1/2008

Last Recertification Date

8/30/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #12136
910 BROAD ST.
BELOIT, WI 53511

Pharmacy Comments

Contract Details

Approval Date

1/15/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Shannon Dunphy-Alexander, Senior Vice President / CFO
(608) 757-3126

Contract Pharmacy Representative

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

Signed By Date

1/15/2020

340B Drug Pricing Program Database