340B Drug Pricing Program Database
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WALGREEN CO.
DSH520096 Ascension All Saints Hospital, Inc.
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Covered Entity Details
Entity Name
Ascension All Saints Hospital, Inc.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520096
Entity Address
3801 SPRING STREET
RACINE, WI 53405
Medicare Provider Number
520096
Participating Start Date
4/1/2004
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07437
3825 DURAND AVE
RACINE, WI 53405-4424
Pharmacy Comments
Contract Details
Approval Date
9/21/2011
Contract Begin Date
9/21/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jon Sohn, CFO
(414) 465-3090
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
8/26/2011
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