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WALGREEN CO
DSH140276 LOYOLA UNIVERSITY MEDICAL CENTER
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Covered Entity Details
Entity Name
LOYOLA UNIVERSITY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140276
Entity Address
2160 SOUTH FIRST AVENUE
MAYWOOD, IL 60153
Medicare Provider Number
140276
Participating Start Date
4/1/2010
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10774
11349 W 159TH ST
ORLAND PARK, IL 60467-5659
Pharmacy Comments
Contract Details
Approval Date
6/1/2012
Contract Begin Date
6/1/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Daniel Post, Executive Vice President
(708) 216-1670
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/4/2012
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