Contract Pharmacy Details

WALGREEN CO.
DSH520096 Ascension All Saints Hospital, Inc.

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 # 03617
3805 80TH ST.
KENOSHA, WI 53142

Pharmacy Comments

Contract Details

Approval Date

12/13/2012

Contract Begin Date

1/1/2013

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jon Sohn, Sr. Vice President and CFO
(414) 465-3090

Contract Pharmacy Representative

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

Signed By Date

10/26/2012

340B Drug Pricing Program Database