Contract Pharmacy Details

WALGREEN CO.
DSH150002 THE METHODIST HOSPITALS

Covered Entity Details

Entity Name

THE METHODIST HOSPITALS

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH150002

Entity Address

600 GRANT ST
GARY, IN 46402

Medicare Provider Number

150002

Participating Start Date

4/1/2003

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 04829
10920 RANDOLPH ST.
CROWN POINT, IN 46307

Pharmacy Comments

Contract Details

Approval Date

4/13/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Matthew Shawn Doyle, President & CEO
(219) 886-4608

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/13/2015

340B Drug Pricing Program Database