Contract Pharmacy Details

WALGREEN CO.
SCH150072-00 MEMORIAL HOSPITAL LOGANSPORT

Covered Entity Details

Entity Name

MEMORIAL HOSPITAL LOGANSPORT

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH150072-00

Entity Address

1101 MICHIGAN AVENUE
LOGANSPORT, IN 46947

Medicare Provider Number

150072

Participating Start Date

7/1/2016

Last Recertification Date

9/19/2022

Entity Termination Date

4/1/2023

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS SPECIALTY PHARMACY #16317
335 MASSACHUSETTS AVENUE
INDIANAPOLIS, IN 46204

Pharmacy Comments

Contract Details

Approval Date

7/13/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Perry Gay, CEO
(574) 753-1385

Contract Pharmacy Representative

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

Signed By Date

7/13/2021

340B Drug Pricing Program Database