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WALGREEN CO.
DSH180088 NORTON HOSPITALS, INC
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Covered Entity Details
Entity Name
NORTON HOSPITALS, INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180088
Entity Address
200 East Chestnut Street
LOUISVILLE, KY 40202
Medicare Provider Number
180088
Participating Start Date
1/1/2004
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05449
3600 FERN VALLEY RD
LOUISVILLE, KY 40219
Pharmacy Comments
Contract Details
Approval Date
10/16/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHAEL W. GOUGH, CHIEF FINANCIAL OFFICER
(502) 420-2212
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2013
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