Contract Pharmacy Details

WALGREEN CO.
DSH430015 AVERA ST. MARY'S

Covered Entity Details

Entity Name

AVERA ST. MARY'S

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH430015

Entity Address

801 E SIOUX
PIERRE, SD 57501

Medicare Provider Number

430015

Participating Start Date

10/1/2014

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 10572
100 E SIOUX AVE
PIERRE, SD 57501-3196

Pharmacy Comments

Contract Details

Approval Date

4/15/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Steve Petersen, Vice President of Pharmacy
(605) 322-8313

Contract Pharmacy Representative

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

Signed By Date

4/15/2021

340B Drug Pricing Program Database