Contract Pharmacy Details

WALGREEN CO.
SCH140015-00 BLESSING HOSPITAL

Covered Entity Details

Entity Name

BLESSING HOSPITAL

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH140015-00

Entity Address

1005 BROADWAY
QUINCY, IL 62301

Medicare Provider Number

140015

Participating Start Date

3/16/2021

Last Recertification Date

8/13/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05886
1215 MAIN STREET
KEOKUK, IA 52632

Pharmacy Comments

Contract Details

Approval Date

1/12/2023

Contract Begin Date

4/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Pat Gerveler, Executive Vice President/Chief Financial Officer
(217) 223-8400 Ext: 6814

Contract Pharmacy Representative

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

Signed By Date

1/12/2023

340B Drug Pricing Program Database