340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALGREEN CO.
DSH160057 Southeast Iowa Regional Medical Center
Print
Covered Entity Details
Entity Name
Southeast Iowa Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160057
Entity Address
1221 SOUTH GEAR AVENUE
WEST BURLINGTON, IA 52655
Medicare Provider Number
160057
Participating Start Date
4/1/2022
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09476
201 S CENTRAL AVENUE
BURLINGTON, IA 52601-5738
Pharmacy Comments
Contract Details
Approval Date
2/16/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Jeremy Alexander, CFO
(319) 768-3280
Contract Pharmacy Representative
Southeast Iowa Regional Medical Center
Steve Frigo, Director, Pharmacy
(319) 768-3971
Signed By Date
2/16/2022
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session