Contract Pharmacy Details

WALGREEN CO.
DSH360027 AKRON GENERAL MEDICAL CENTER

Covered Entity Details

Entity Name

AKRON GENERAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH360027

Entity Address

1 AKRON GENERAL AVE
AKRON, OH 44307

Medicare Provider Number

360027

Participating Start Date

7/1/2021

Last Recertification Date

8/22/2023

Entity Termination Date

7/1/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #11143
3009 W. MARKET ST.
FAIRLAWN, OH 44333-3610

Pharmacy Comments

Contract Details

Approval Date

6/2/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Brian Harte, President
(330) 344-6548

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/14/2021

340B Drug Pricing Program Database