Contract Pharmacy Details

WALGREEN CO.
DSH160024 IOWA LUTHERAN HOSPITAL

Covered Entity Details

Entity Name

IOWA LUTHERAN HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH160024

Entity Address

700 EAST UNIVERSITY AVENUE
DES MOINES, IA 50316

Medicare Provider Number

160024

Participating Start Date

1/1/2009

Last Recertification Date

9/3/2018

Entity Termination Date

10/1/2019

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05060
12753 UNIVERSITY AVE
CLIVE, IA 50325

Pharmacy Comments

Contract Details

Approval Date

4/10/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Stephen R. Stephenson, EVP Iowa Health Des Moines
(515) 241-5858

Contract Pharmacy Representative

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

Signed By Date

4/10/2013

340B Drug Pricing Program Database