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WALGREEN CO.
DSH260102 Truman Medical Center, Incorporated dba University Health Lakewood Medical Center
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Covered Entity Details
Entity Name
Truman Medical Center, Incorporated dba University Health Lakewood Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260102
Entity Address
7900 Lee's Summit Road
Kansas City, MO 64139
Medicare Provider Number
260102
Participating Start Date
4/1/2001
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04185
4951 ROE BLVD.
ROELAND PARK, KS 66205
Pharmacy Comments
Contract Details
Approval Date
7/15/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/27/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John W. Bluford, President and CEO
(816) 404-3500
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2013
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