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Walgreens Central Fill #21399
DSH150113 COMMUNITY HOSPITAL ANDERSON
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Covered Entity Details
Entity Name
COMMUNITY HOSPITAL ANDERSON
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150113
Entity Address
1515 NORTH MADISON AVE
ANDERSON, IN 46011
Medicare Provider Number
150113
Participating Start Date
4/1/2021
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
Walgreens Central Fill #21399
Pharmacy Address
4132Plainfield Rd
Ste 110
Indianapolis, IN 46231-7021
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/12/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Beth Tharp, SVP/President of Hospital Services
(765) 298-5125
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/17/2023
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