Contract Pharmacy Details

WALGREEN CO.
DSH370037 SSM ST ANTHONY HOSPITAL

Covered Entity Details

Entity Name

SSM ST ANTHONY HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH370037

Entity Address

1000 N Lee Ave
OKLAHOMA CITY, OK 73102

Medicare Provider Number

370037

Participating Start Date

10/1/2006

Last Recertification Date

8/31/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 02543
2345 N CLASSEN BLVD
OKLAHOMA CITY, OK 73106-5804

Pharmacy Comments

04/25/2012 address update (added N to line 1)

Contract Details

Approval Date

2/21/2012

Contract Begin Date

2/21/2012

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Shasta Manuel, Regional Vice President Finance/CFO
(405) 272-7279

Contract Pharmacy Representative

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

Signed By Date

2/9/2012

340B Drug Pricing Program Database