Contract Pharmacy Details

WALGREEN CO.
DSH520177 FROEDTERT MEMORIAL LUTHERAN HOSPITAL

Covered Entity Details

Entity Name

FROEDTERT MEMORIAL LUTHERAN HOSPITAL

Subdivision Name

FORMERLY JOHN L. DOYNE HOSPITAL

Type

Disproportionate Share Hospital

340B ID

DSH520177

Entity Address

9200 WEST WISCONSIN AVENUE
MILWAUKEE, WI 53226

Medicare Provider Number

520177

Participating Start Date

7/1/1996

Last Recertification Date

8/21/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 03616
8488 W. BROWN DEER RD
MILWAUKEE, WI 53224

Pharmacy Comments

Contract Details

Approval Date

3/8/2012

Contract Begin Date

3/8/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/11/2015
Pharmacy closed

Contacts

Covered Entity Signing Official

Jeffrey Van De Kreeke, CFO
(414) 777-0968

Contract Pharmacy Representative

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

Signed By Date

3/7/2012

340B Drug Pricing Program Database