Contract Pharmacy Details

WALGREEN CO.
DSH520078 Ascension St. Francis Hospital, Inc.

Covered Entity Details

Entity Name

Ascension St. Francis Hospital, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH520078

Entity Address

3237 SOUTH 16TH STREET
MILWAUKEE, WI 53215

Medicare Provider Number

520078

Participating Start Date

10/1/2006

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 03578
2275 NORTH MAYFAIR ROAD
WAUWATOSA, WI 53226

Pharmacy Comments

Contract Details

Approval Date

10/26/2012

Contract Begin Date

10/26/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2024
Business decision by covered entity and/or pharmacy

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

10/26/2012

340B Drug Pricing Program Database