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WALGREEN CO.
DSH140064 ST. MARY MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. MARY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140064
Entity Address
3333 N SEMINARY Street
GALESBURG, IL 61401
Medicare Provider Number
140064
Participating Start Date
7/1/2023
Last Recertification Date
9/3/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11881
600 N MAIN ST
MONMOUTH, IL 61462
Pharmacy Comments
Contract Details
Approval Date
5/22/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Diane L. McGrew, President
(309) 655-2850
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2023
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