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WALGREEN CO.
DSH150109 FRANCISCAN HEALTH LAFAYETTE
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Covered Entity Details
Entity Name
FRANCISCAN HEALTH LAFAYETTE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150109
Entity Address
1701 SOUTH CREASY LANE
LAFAYETTE, IN 47905
Medicare Provider Number
150109
Participating Start Date
4/26/2021
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06456
1000 SAGAMORE PKWY W
WEST LAFAYETTE, IN 47906
Pharmacy Comments
Contract Details
Approval Date
8/31/2012
Contract Begin Date
8/31/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
JEFFERY T. DEAKYNE, DIVISION DIRECTOR OF FINANCE
(765) 428-5928
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
8/27/2012
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