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WALGREEN CO.
DSH370149 St Anthony Shawnee Hospital
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Covered Entity Details
Entity Name
St Anthony Shawnee Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370149
Entity Address
1102 West MacArthur St
SHAWNEE, OK 74804
Medicare Provider Number
370149
Participating Start Date
4/1/2010
Last Recertification Date
9/1/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03668
7101 W. HEFNER RD.
OKLAHOMA CITY, OK 73162
Pharmacy Comments
Contract Details
Approval Date
1/14/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Charles Skillings, CEO
(405) 878-8110
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2014
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