Contract Pharmacy Details

WALGREEN CO.
CAH141301-00 Kirby Medical Center

Covered Entity Details

Entity Name

Kirby Medical Center

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH141301-00

Entity Address

1000 Medical Center Drive
Monticello, IL 61856

Medicare Provider Number

141301

Participating Start Date

4/1/2013

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 09792
625 W PERSHING RD
DECATUR, IL 62526

Pharmacy Comments

Contract Details

Approval Date

10/4/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Steven D. Tenhouse, Chief Executive Officer
(217) 762-2115 Ext: 1501

Contract Pharmacy Representative

Walgreens
Andrea Koper, 340B Client Relations
(847) 964-6077

Signed By Date

10/4/2021

340B Drug Pricing Program Database