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WALGREEN CO.
DSH140088 THE UNIVERSITY OF CHICAGO MEDICAL CENTER
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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 # 05713
4740 W. 95TH STREET
OAK LAWN, IL 60453
Pharmacy Comments
Contract Details
Approval Date
9/21/2012
Contract Begin Date
9/21/2012
Carve-In Effective Date
Contract Comments
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
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