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 # 06834
4400 NW 23RD STREET
OKLAHOMA CITY, OK 73107-2644

Pharmacy Comments

Contract Details

Approval Date

10/13/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2025
Pharmacy closed

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

10/13/2016

340B Drug Pricing Program Database