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WALGREEN CO.
DSH520035 AURORA HEALTH CARE CENTRAL INC.DBA AURORA SHEBOYGAN MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
AURORA HEALTH CARE CENTRAL INC.DBA AURORA SHEBOYGAN MEMORIAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520035
Entity Address
3400 UNION AVE
SHEBOYGAN, WI 53081
Medicare Provider Number
520035
Participating Start Date
7/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS SPECIALTY PHARMACY #21254
2265 N MAYFAIR RD.
WAUWATOSA, WI 53226
Pharmacy Comments
Contract Details
Approval Date
2/24/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nan Nelson, SVP-Finance
(414) 378-4765
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
2/24/2022
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