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Walgreens Central Fill #21399
CAH141344-00 LAWRENCE COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
LAWRENCE COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141344-00
Entity Address
2200 STATE STREET
LAWRENCEVILLE, IL 62439
Medicare Provider Number
141344
Participating Start Date
1/1/2016
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
Walgreens Central Fill #21399
Pharmacy Address
4132Plainfield Rd
Ste 110
Indianapolis, IN 46231-7021
Pharmacy Comments
Contract Details
Approval Date
4/14/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/14/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Carl H Aten, Board Chairman
(618) 843-8424
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/14/2023
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