Contract Pharmacy Details

WALGREEN CO.
DSH180088 NORTON HOSPITALS, INC

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 # 07064
9409 SHELBYVILLE ROAD
LOUISVILLE, KY 40222

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

340B Drug Pricing Program Database