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WALGREEN CO
DSH140029 COPLEY MEMORIAL HOSPITAL
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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
4400 STATE RD 19
WINDSOR, WI 53598
Pharmacy Comments
Contract Details
Approval Date
2/25/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/5/2017
Business decision by covered entity and/or pharmacy
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
1/14/2013
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