Contract Pharmacy Details

WALGREEN CO.
DSH260005 SSM HEALTH ST. JOSEPH HOSPITAL- SC

Covered Entity Details

Entity Name

SSM HEALTH ST. JOSEPH HOSPITAL- SC

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH260005

Entity Address

300 FIRST CAPITOL DRIVE
ST. CHARLES, MO 63301

Medicare Provider Number

260005

Participating Start Date

10/1/2010

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 02617
2329 W CLAY ST
ST CHARLES, MO 63301

Pharmacy Comments

Contract Details

Approval Date

4/14/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/5/2019
Ownership change

Contacts

Covered Entity Signing Official

Karen D. Rewerts, Regional VP of Financa/CFO
(314) 989-2034

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/14/2015

340B Drug Pricing Program Database