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WALGREENS SPECIALTY PHARMACY, LLC
DSH140209 METHODIST MEDICAL CENTER OF ILLINOIS
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Covered Entity Details
Entity Name
METHODIST MEDICAL CENTER OF ILLINOIS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140209
Entity Address
221 NE GLEN OAK AVE.
PEORIA, IL 61636
Medicare Provider Number
140209
Participating Start Date
10/1/2006
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
4/16/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert A. Quin, Chief Financial Officer
(309) 672-4893
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2020
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