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WALGREEN CO.
DSH140083 LORETTO HOSPITAL
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Covered Entity Details
Entity Name
LORETTO HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140083
Entity Address
645 SOUTH CENTRAL
CHICAGO, IL 60644
Medicare Provider Number
140083
Participating Start Date
12/6/2005
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05867
3943 W 47TH STREET
CHICAGO, IL 60632-4145
Pharmacy Comments
Contract Details
Approval Date
4/20/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Morales, Interim CFO
(773) 854-5438
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/20/2023
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