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WALGREEN CO.
DSH180141 UNIVERSITY OF LOUISVILLE HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF LOUISVILLE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180141
Entity Address
530 SOUTH JACKSON STREET
LOUISVILLE, KY 40202
Medicare Provider Number
180141
Participating Start Date
7/1/1996
Last Recertification Date
8/31/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07064
9409 SHELBYVILLE ROAD
LOUISVILLE, KY 40222
Pharmacy Comments
Contract Details
Approval Date
10/28/2011
Contract Begin Date
10/28/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/30/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JAMES TAYLOR, CEO
(502) 562-4002
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/14/2011
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