340B Drug Pricing Program Database
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WALGREEN CO.
DSH160146 ST. LUKE'S REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. LUKE'S REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160146
Entity Address
2720 STONE PARK BLVD
SIOUX CITY, IA 51104
Medicare Provider Number
160146
Participating Start Date
1/1/2009
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #15647
1900 HAMILTON BLVD
SIOUX CITY, IA 51104
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James L. Gobell, CFO
(712) 279-3949
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/14/2021
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