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WALGREEN CO.
DSH150065 SCHNECK MEDICAL CENTER
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Covered Entity Details
Entity Name
SCHNECK MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150065
Entity Address
411 WEST TIPTON STREET
SEYMOUR, IN 47274
Medicare Provider Number
150065
Participating Start Date
10/1/2016
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17009
803 S. MAIN ST.
SALEM, IN 47167
Pharmacy Comments
Contract Details
Approval Date
7/9/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Deborah Ridlen, VP Finance/CFO
(812) 522-0170
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/9/2021
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