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WALGREENS SPECIALTY PHARMACY, LLC
DSH140067 SAINT FRANCIS MEDICAL CENTER
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Covered Entity Details
Entity Name
SAINT FRANCIS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140067
Entity Address
530 NE GLEN OAK AVENUE
PEORIA, IL 61637
Medicare Provider Number
140067
Participating Start Date
10/1/2006
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
ALLIANCERX WALGREENS PRIME #12314
9775 SW GEMINI DR, STE 1
BEAVERTON, OR 97008
Pharmacy Comments
Contract Details
Approval Date
4/13/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Diane L. McGrew, President
(309) 655-2850
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/13/2020
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