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WALGREEN CO.
DSH150015 FRANCISCAN HEALTH MICHIGAN CITY
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Covered Entity Details
Entity Name
FRANCISCAN HEALTH MICHIGAN CITY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150015
Entity Address
3500 FRANCISCAN WAY
MICHIGAN CITY, IN 46360
Medicare Provider Number
150015
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03680
1903 CALUMET AVE.
VALPARAISO, IN 46383
Pharmacy Comments
Contract Details
Approval Date
7/22/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Justin Kats, Division CFO - Crown Point & Michigan City
(219) 757-6403
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/11/2024
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