340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALGREEN CO.
CAH521338-00 PRAIRIE RIDGE HEALTH, INC.
Print
Covered Entity Details
Entity Name
PRAIRIE RIDGE HEALTH, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521338-00
Entity Address
1515 PARK AVENUE
COLUMBUS, WI 53925-1618
Medicare Provider Number
521338
Participating Start Date
1/1/2014
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03291
275 DAVISON DR
SUN PRAIRIE, WI 53590
Pharmacy Comments
Contract Details
Approval Date
7/13/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Phillip G. Roberts, Vice President and CFO
(920) 623-1368
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/13/2017
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session