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WALGREEN CO.
DSH240047 St. Luke's Hospital of Duluth
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Covered Entity Details
Entity Name
St. Luke's Hospital of Duluth
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240047
Entity Address
915 East First Street
Duluth, MN 55805
Medicare Provider Number
240047
Participating Start Date
10/1/2013
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #13163
18 SE 10TH ST
GRAND RAPIDS, MN 55744
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/27/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Eric Lohn, Vice President/CFO
(218) 249-5475
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2020
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