Contract Pharmacy Details

WALGREEN CO.
DSH140029 COPLEY MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

COPLEY MEMORIAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140029

Entity Address

2000 OGDEN AVENUE
AURORA, IL 60504

Medicare Provider Number

140029

Participating Start Date

4/1/2008

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 06937
1221 N LAKE STREET
AURORA, IL 60506-2454

Pharmacy Comments

01/15/2014 - Pharmacy name/address correction, changed in error on 3/28/2013.

Contract Details

Approval Date

6/15/2012

Contract Begin Date

6/15/2012

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Brenda VanWyhe, SENIOR VP FINANCE AND CFO
(630) 898-3565

Contract Pharmacy Representative

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

Signed By Date

6/5/2013

340B Drug Pricing Program Database