Contract Pharmacy Details

WALGREEN CO.
DSH140275 GENESIS MEDICAL CENTER - SILVIS

Covered Entity Details

Entity Name

GENESIS MEDICAL CENTER - SILVIS

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140275

Entity Address

801 Illini Drive
Silvis, IL 61282

Medicare Provider Number

140275

Participating Start Date

1/1/2019

Last Recertification Date

8/14/2023

Entity Termination Date

1/1/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS SPECIALTY PHARMACY #21254
2265 N MAYFAIR RD.
WAUWATOSA, WI 53226

Pharmacy Comments

Contract Details

Approval Date

7/9/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Theresa Main, GMC Silvis President
(309) 281-5146

Contract Pharmacy Representative

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

Signed By Date

7/9/2021

340B Drug Pricing Program Database