Contract Pharmacy Details

WALGREEN CO.
DSH240106 REGIONS HOSPITAL

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 # 01951
612 4TH ST NW
FARIBAULT, MN 55021-5035

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

340B Drug Pricing Program Database