Contract Pharmacy Details

WALGREEN CO
DSH140088 THE UNIVERSITY OF CHICAGO MEDICAL CENTER

Covered Entity Details

Entity Name

THE UNIVERSITY OF CHICAGO MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140088

Entity Address

5841 S. MARYLAND AVE.
CHICAGO, IL 60637

Medicare Provider Number

140088

Participating Start Date

10/1/2003

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA: WALGREENS #10937
5640 211TH ST
MATTESON, IL 60443

Pharmacy Comments

Contract Details

Approval Date

9/21/2012

Contract Begin Date

9/21/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/31/2017
Pharmacy closed

Contacts

Covered Entity Signing Official

James Watson, Chief Financial Officer
(773) 834-2802

Contract Pharmacy Representative

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

Signed By Date

9/21/2012

340B Drug Pricing Program Database