Contract Pharmacy Details

WALGREEN CO.
DSH520138 AURORA HEALTH CARE METRO, INC.

Covered Entity Details

Entity Name

AURORA HEALTH CARE METRO, INC.

Subdivision Name

Aurora St. Luke's Medical Center

Type

Disproportionate Share Hospital

340B ID

DSH520138

Entity Address

2900 W OKLAHOMA AVE
MILWAUKEE, WI 53215

Medicare Provider Number

520138

Participating Start Date

10/1/2010

Last Recertification Date

8/14/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05417
6125 DURAND AVE.
MT PLEASANT, WI 53406

Pharmacy Comments

Contract Details

Approval Date

7/17/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

GAIL HANSON, CFO
(414) 299-1623

Contract Pharmacy Representative

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

Signed By Date

7/17/2017

340B Drug Pricing Program Database