340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALGREEN CO.
DSH160153 MERCYONE SIOUXLAND MEDICAL CENTER
Print
Covered Entity Details
Entity Name
MERCYONE SIOUXLAND MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160153
Entity Address
801 FIFTH STREET
SIOUX CITY, IA 51101
Medicare Provider Number
160153
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 10502
1030 W 21ST ST
SOUTH SIOUX CITY, NE 68776-2661
Pharmacy Comments
Contract Details
Approval Date
1/17/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jesica Hanson, VP of Finance
(712) 279-5850
Contract Pharmacy Representative
Walgreens
Chrysta Nikols, 340B Client Relationship Analyst
(847) 315-5335
Signed By Date
1/13/2025
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session