Contract Pharmacy Details

WALGREEN CO
DSH140239 Javon Bea Hospital

Covered Entity Details

Entity Name

Javon Bea Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140239

Entity Address

8201 E Riverside Blvd
Rockford, IL 61114

Medicare Provider Number

140239

Participating Start Date

1/1/2008

Last Recertification Date

8/30/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA; WALGREENS #12583
1704 E. RIVERSIDE BLVD
LOVES PARK, IL 61111

Pharmacy Comments

Contract Details

Approval Date

7/10/2015

Contract Begin Date

10/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Henry Seybold, Senior Vice President / CFO
(815) 971-6796

Contract Pharmacy Representative

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

Signed By Date

7/10/2015

340B Drug Pricing Program Database