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WALGREEN CO.
DSH140158 Insight Hospital and Medical Center Chicago
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Covered Entity Details
Entity Name
Insight Hospital and Medical Center Chicago
Subdivision Name
MAIN SITE
Type
Disproportionate Share Hospital
340B ID
DSH140158
Entity Address
2525 S. MICHIGAN AVENUE
CHICAGO, IL 60616
Medicare Provider Number
140158
Participating Start Date
7/1/2004
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07876
7544 S STONY ISLAND AVE
CHICAGO, IL 60649-3926
Pharmacy Comments
Corrected zipcode
Contract Details
Approval Date
10/31/2011
Contract Begin Date
11/4/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/15/2015
Pharmacy closed
Contacts
Covered Entity Signing Official
SHEILA LYNE, PRESIDENT &CEO
(312) 567-2100
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
11/4/2011
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