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WALGREEN CO.
PED363302-00 UNIVERSITY HOSPITALS RAINBOW BABIES AND CHILDREN'S HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITALS RAINBOW BABIES AND CHILDREN'S HOSPITAL
Subdivision Name
Type
Children's Hospital
340B ID
PED363302-00
Entity Address
11100 EUCLID AVENUE
CLEVELAND, OH 44106
Medicare Provider Number
363302
Participating Start Date
11/13/2009
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #21321
4546 MAYFIELD RD
SOUTH EUCLID, OH 44121-4043
Pharmacy Comments
Contract Details
Approval Date
4/6/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael R. Vehovec, Corporate Controller
(216) 767-8729
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/6/2021
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