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WALGREENS SPECIALTY PHARMACY, LLC
DSH150056 INDIANA UNIVERSITY HEALTH INC
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Covered Entity Details
Entity Name
INDIANA UNIVERSITY HEALTH INC
Subdivision Name
Methodist Hospital
Type
Disproportionate Share Hospital
340B ID
DSH150056
Entity Address
1701 N. Senate Blvd
INDIANAPOLIS, IN 46202
Medicare Provider Number
150056
Participating Start Date
4/1/2004
Last Recertification Date
8/12/2024
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
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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