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WALGREEN CO.
DSH150089 INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INC.
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Covered Entity Details
Entity Name
INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150089
Entity Address
2401 W. UNIVERSITY AVENUE
MUNCIE, IN 47303
Medicare Provider Number
150089
Participating Start Date
1/1/2010
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05803
2720 W JACKSON
MUNCIE, IN 47303
Pharmacy Comments
Contract Details
Approval Date
10/9/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jennifer M. Alvey, SVP & CFO
(317) 963-0213
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/9/2020
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