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WALGREEN CO.
CAH151330-00 ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151330-00
Entity Address
1100 MERCER AVE
DECATUR, IN 46733-0151
Medicare Provider Number
151330
Participating Start Date
9/14/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09893
123 N 13TH ST
DECATUR, IN 46733-1409
Pharmacy Comments
Contract Details
Approval Date
10/7/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2017
Pharmacy closed
Contacts
Covered Entity Signing Official
JO-ELLEN EIDAM, CEO
(260) 724-2145 Ext: 1400
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/7/2014
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