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Walgreen CO
CAH141318-00 OSF Holy Family Medical Center
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Covered Entity Details
Entity Name
OSF Holy Family Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141318-00
Entity Address
1000 West Harlem Ave
Monmouth, IL 61462
Medicare Provider Number
141318
Participating Start Date
1/1/2013
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
Walgreen CO
Pharmacy Address
DBA Walgreens Central Fill #21417
599 S Schmidt Rd
Ste A
Bolingbrook, IL 60440-9405
Pharmacy Comments
Contract Details
Approval Date
4/12/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
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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