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Walgreen CO
DSH140114 SWEDISH COVENANT HEALTH
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Covered Entity Details
Entity Name
SWEDISH COVENANT HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140114
Entity Address
5145 N CALIFORNIA
CHICAGO, IL 60625
Medicare Provider Number
140114
Participating Start Date
7/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
Walgreen CO
Pharmacy Address
DBA Walgreens Central Fill #21417
599 S Schmidt Rd
Ste A
Bolingbrook, IL 60440-9405
Pharmacy Comments
Contract Details
Approval Date
7/6/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jonathan Lind, Chief Operating Officer
(773) 907-1028 Ext: 1028
Contract Pharmacy Representative
Walgreens Co
Eliza Pavel, Client Relationship
(847) 315-7763
Signed By Date
7/6/2023
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