Contract Pharmacy Details

WALGREEN CO.
DSH520098 UNIVERSITY OF WI HOSPITALS & CLINICS

Covered Entity Details

Entity Name

UNIVERSITY OF WI HOSPITALS & CLINICS

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH520098

Entity Address

600 HIGHLAND AVE
MADISON, WI 53792

Medicare Provider Number

520098

Participating Start Date

7/1/2022

Last Recertification Date

8/23/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 09008
403 GATEWAY AVE
MAUSTON, WI 53948

Pharmacy Comments

Contract Details

Approval Date

4/14/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Robert W Flannery, Senior VP/Chief Financial Officer
(608) 265-7131

Contract Pharmacy Representative

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

Signed By Date

4/6/2022

340B Drug Pricing Program Database