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

WALGREENS PHARMACY AT CRUSADERS #21287
1200 W STATE ST STE 102
ROCKFORD, IL 61102-2112

Pharmacy Comments

Contract Details

Approval Date

1/13/2017

Contract Begin Date

4/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

John Cook, Senior Vice President / CFO
(608) 756-6642

Contract Pharmacy Representative

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

Signed By Date

1/13/2017

340B Drug Pricing Program Database