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WALGREEN CO.
DSH150004 FRANCISCAN HEALTH HAMMOND
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Covered Entity Details
Entity Name
FRANCISCAN HEALTH HAMMOND
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150004
Entity Address
5454 HOHMAN AVE
HAMMOND, IN 46320
Medicare Provider Number
150004
Participating Start Date
4/1/2013
Last Recertification Date
8/31/2022
Entity Termination Date
1/1/2023
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05787
651 W. US HWY 30
SCHERERVILLE, IN 46375
Pharmacy Comments
Contract Details
Approval Date
4/19/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
TOM GRYZBEK, PRESIDENT
(219) 933-2074
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/19/2013
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