Contract Pharmacy Details

WALGREEN CO.
DSH130071 St. Luke's Nampa Medical Center

Covered Entity Details

Entity Name

St. Luke's Nampa Medical Center

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH130071

Entity Address

9850 W ST LUKES DRIVE
Nampa, ID 83687

Medicare Provider Number

130071

Participating Start Date

7/1/2019

Last Recertification Date

8/27/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #11687
4850 N LINDER RD
MERIDIAN, ID 83646

Pharmacy Comments

Contract Details

Approval Date

10/7/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Peter DiDio, Vice President, Controller
(208) 381-1251

Contract Pharmacy Representative

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

Signed By Date

10/7/2021

340B Drug Pricing Program Database