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WALGREEN CO.
DSH140228 SWEDISH AMERICAN HOSPITAL
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Covered Entity Details
Entity Name
SWEDISH AMERICAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140228
Entity Address
1401 E STATE ST
ROCKFORD, IL 61104
Medicare Provider Number
140228
Participating Start Date
9/9/2005
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12126
1680 WEST LANE RD.
MACHESNEY PARK, IL 61115
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DON HARING, CFO
(815) 968-4400
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2014
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