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WALGREEN CO
DSH180141 UNIVERSITY OF LOUISVILLE HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF LOUISVILLE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180141
Entity Address
530 SOUTH JACKSON STREET
LOUISVILLE, KY 40202
Medicare Provider Number
180141
Participating Start Date
7/1/1996
Last Recertification Date
8/31/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #11663
6301 HIGHWAY 329
CRESTWOOD, KY 40014-9040
Pharmacy Comments
Contract Details
Approval Date
4/10/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/27/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Steve Amsler, Senior Vice President of Operations
(502) 562-4122
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/10/2020
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