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WALGREEN CO
DSH180138 Baptist Health Lagrange
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Covered Entity Details
Entity Name
Baptist Health Lagrange
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180138
Entity Address
1025 New Moody Lane
La Grange, KY 40031
Medicare Provider Number
180138
Participating Start Date
7/1/2013
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #09412
5100 DIXIE HWY
LOUISVILLE, KY 40216
Pharmacy Comments
Contract Details
Approval Date
6/2/2023
Contract Begin Date
6/2/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Clint Kaho, President
(502) 222-3329
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/2/2023
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