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WALGREEN CO.
DSH240106 REGIONS HOSPITAL
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Covered Entity Details
Entity Name
REGIONS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240106
Entity Address
640 JACKSON ST.
ST. PAUL, MN 55101
Medicare Provider Number
240106
Participating Start Date
12/1/1992
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 00430
5695 DULUTH ST
GOLDEN VALLEY, MN 55422
Pharmacy Comments
Contract Details
Approval Date
12/3/2012
Contract Begin Date
12/3/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/20/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
HEIDI CONRAD, CFO
(651) 254-0900
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
9/27/2012
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