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WALGREEN CO.
DSH360112 MERCY HEALTH - ST. VINCENT MEDICAL CENTER
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Covered Entity Details
Entity Name
MERCY HEALTH - ST. VINCENT MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360112
Entity Address
2213 CHERRY STREET
TOLEDO, OH 43608
Medicare Provider Number
360112
Participating Start Date
1/1/2005
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09409
10003 FREMONT PIKE
PERRYSBURG, OH 43551-3330
Pharmacy Comments
Contract Details
Approval Date
1/16/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Donald E. Kline, Chief Financial Officer, Northern Division
(330) 884-7118
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/16/2015
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