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WALGREEN CO.
DSH150084 ST. VINCENT HOSPITAL AND HEALTH CARE CENTER D/B/A Ascension St. Vincent Indianapolis
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Covered Entity Details
Entity Name
ST. VINCENT HOSPITAL AND HEALTH CARE CENTER D/B/A Ascension St. Vincent Indianapolis
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150084
Entity Address
2001 WEST 86TH STREET
INDIANAPOLIS, IN 46260
Medicare Provider Number
150084
Participating Start Date
9/3/2008
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 02796
3003 KESSLER BLVD NORTH DR
INDIANAPOLIS, IN 46222
Pharmacy Comments
Contract Details
Approval Date
11/9/2012
Contract Begin Date
11/9/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/26/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Thomas Cook, CFO
(317) 338-9769
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
11/9/2012
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