Contract Pharmacy Details

WALGREEN CO
DSH140276 LOYOLA UNIVERSITY MEDICAL CENTER

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 #09925
2S613 STATE ROUTE 59
WARRENVILLE, IL 60555

Pharmacy Comments

Contract Details

Approval Date

6/1/2012

Contract Begin Date

6/1/2012

Carve-In Effective Date

Contract Comments

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

340B Drug Pricing Program Database