340B Drug Pricing Program Database
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WALGREEN CO.
DSH140185 MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140185
Entity Address
4500 MEMORIAL DRIVE
BELLEVILLE, IL 62226
Medicare Provider Number
140185
Participating Start Date
7/1/2024
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15311
115 N EUCLID AVE STE A
SAINT LOUIS, MO 63108
Pharmacy Comments
Contract Details
Approval Date
4/30/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Susan Koesterer, VP, Chief Financial Officer
(314) 653-5715
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/10/2024
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