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WALGREEN CO.
DSH150074 Community Health Network, Inc.
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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 # 03065
4555 N SHADELAND AVE
INDIANAPOLIS, IN 46226
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
11/9/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
9/22/2010
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