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WALGREEN CO.
DSH360035 MOUNT CARMEL HEALTH
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Covered Entity Details
Entity Name
MOUNT CARMEL HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360035
Entity Address
6001 E Broad St
Columbus, OH 43213-1502
Medicare Provider Number
360035
Participating Start Date
4/1/2017
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 01317
3445 S HIGH ST
COLUMBUS, OH 43207
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
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