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WALGREEN CO.
DSH360003 University of Cincinnati Medical Center LLC
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Covered Entity Details
Entity Name
University of Cincinnati Medical Center LLC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360003
Entity Address
3188 Bellevue Avenue
CINCINNATI, OH 45219
Medicare Provider Number
360003
Participating Start Date
12/1/1992
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06787
3084 W GALBRAITH ROAD
CINCINNATI, OH 45239-4282
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
10/9/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RICK HINDS, Executive Vice President and Chief Financial Officer
(513) 585-8720
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/13/2020
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