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WALGREENS MAIL SERVICE, INC.
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
WALGREENS MAIL SERVICE, INC.
Pharmacy Address
8337 S PARK CIRCLE
ORLANDO, FL 32819-9049
Pharmacy Comments
Contract Details
Approval Date
3/1/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/9/2015
Business decision by covered entity and/or pharmacy
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
1/15/2013
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