Contract Pharmacy Details

WALGREEN CO.
DSH150074 Community Health Network, Inc.

Covered Entity Details

Entity Name

Community Health Network, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH150074

Entity Address

1500 N. RITTER AVE.
INDIANAPOLIS, IN 46219

Medicare Provider Number

150074

Participating Start Date

4/1/2008

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 03194
9050 E. 38TH STREET
INDIANAPOLIS, IN 46235

Pharmacy Comments

Contract Details

Approval Date

9/30/2010

Contract Begin Date

10/18/2010

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/15/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Signed By Date

9/22/2010

340B Drug Pricing Program Database