Contract Pharmacy Details

WALGREEN CO.
DSH360012 ST. ANN'S HOSP OF COLUMBUS INC,

Covered Entity Details

Entity Name

ST. ANN'S HOSP OF COLUMBUS INC,

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH360012

Entity Address

500 SOUTH CLEVELAND AVE
WESTERVILLE, OH 43081-0000

Medicare Provider Number

360012

Participating Start Date

1/1/2016

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #13007
1040 POLARIS PARKWAY
COLUMBUS, OH 43240-2005

Pharmacy Comments

Contract Details

Approval Date

1/11/2023

Contract Begin Date

4/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Nicholas Kreatsoulas, Executive Vice President & Chief Clinical Operations Officer
(614) 546-3266

Contract Pharmacy Representative

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

Signed By Date

1/11/2023

340B Drug Pricing Program Database