Contract Pharmacy Details

WALGREEN CO.
DSH140095 SAINT ANTHONY HOSPITAL

Covered Entity Details

Entity Name

SAINT ANTHONY HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140095

Entity Address

2875 WEST 19TH STREET
CHICAGO, IL 60623

Medicare Provider Number

140095

Participating Start Date

7/1/2003

Last Recertification Date

8/27/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 00226
4005 W 26TH STREET
CHICAGO, IL 60623

Pharmacy Comments

Contract Details

Approval Date

9/28/2012

Contract Begin Date

9/28/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/18/2025
Pharmacy closed

Contacts

Covered Entity Signing Official

Jill Stemmerman, Vice President
(773) 484-4470

Contract Pharmacy Representative

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

Signed By Date

9/28/2012

340B Drug Pricing Program Database