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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 # 04973
7000 DOUGLAS AVE
URBANDALE, IA 50322
Pharmacy Comments
Contract Details
Approval Date
7/6/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Eric Lothe, SVP/COO
(515) 241-5858
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/6/2017
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