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WALGREEN CO.
DSH160024 IOWA LUTHERAN HOSPITAL
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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 # 07454
901 N ANKENY BLVD
ANKENY, IA 50023-4002
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
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