Contract Pharmacy Details

WALGREEN CO.
DSH260091 SSM HEALTH ST MARY'S HOSPITAL-STL

Covered Entity Details

Entity Name

SSM HEALTH ST MARY'S HOSPITAL-STL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH260091

Entity Address

6420 CLAYTON ROAD
ST. LOUIS, MO 63117

Medicare Provider Number

260091

Participating Start Date

10/1/2006

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05552
920 N MAIN ST
OFALLON, MO 63366

Pharmacy Comments

Contract Details

Approval Date

7/4/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/12/2019
Ownership change

Contacts

Covered Entity Signing Official

Karen D. Rewerts, Regional VP of Financa/CFO
(314) 989-2034

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/4/2017

340B Drug Pricing Program Database