340B Drug Pricing Program Database
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WALGREEN CO.
CAH521350-00 LANGLADE HOSPITAL - HOTEL DIEU OF ST. JOSEPH OF ANTIGO WISCONSIN; DBA ASPIRUS LANGLADE HOSPITAL
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Covered Entity Details
Entity Name
LANGLADE HOSPITAL - HOTEL DIEU OF ST. JOSEPH OF ANTIGO WISCONSIN; DBA ASPIRUS LANGLADE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521350-00
Entity Address
112 E. 5TH AVENUE
ANTIGO, WI 54409
Medicare Provider Number
521350
Participating Start Date
4/1/2011
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 01158
900 1ST AVENUE
WOODRUFF, WI 54568
Pharmacy Comments
Contract Details
Approval Date
4/15/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/30/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Patrick Tincher, Director of Finance/CFO
(715) 623-9215
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2013
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