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WALGREEN CO.
RRC140127-00 CARLE BROMENN MEDICAL CENTER
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Covered Entity Details
Entity Name
CARLE BROMENN MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC140127-00
Entity Address
1304 VIRGINIA
NORMAL, IL 61761
Medicare Provider Number
140127
Participating Start Date
2/17/2021
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09983
1408 N. MAIN ST
BLOOMINGTON, IL 61701
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dennis P. Hesch, Executive VP and CFO
(217) 326-8231
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/14/2021
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