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WALGREEN CO.
DSH370094 SSM Health St Anthony Hospital - Midwest
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Covered Entity Details
Entity Name
SSM Health St Anthony Hospital - Midwest
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370094
Entity Address
2825 Parklawn Dr
MIDWEST CITY, OK 73110
Medicare Provider Number
370094
Participating Start Date
4/1/2022
Last Recertification Date
8/31/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03643
9011 SOUTH PENNSYLVANIA AVE
OKLAHOMA CITY, OK 73159
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shasta Manuel, VP of Finance CFO
(405) 272-7282
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/17/2023
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