Contract Pharmacy Details

WALGREEN CO.
DSH140054 MACNEAL HOSPITAL

Covered Entity Details

Entity Name

MACNEAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140054

Entity Address

3249 SOUTH OAK PARK AVENUE
BERWYN, IL 60402

Medicare Provider Number

140054

Participating Start Date

1/1/2019

Last Recertification Date

9/10/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #15506
3303 W. 26TH STREET
SUITE 101
CHICAGO, IL 60623

Pharmacy Comments

Contract Details

Approval Date

1/16/2023

Contract Begin Date

4/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Melissa M. Lukasick, CFO Illinois Region
(708) 216-5723

Contract Pharmacy Representative

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

Signed By Date

1/16/2023

340B Drug Pricing Program Database