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WALGREEN CO.
DSH360133 Kettering Health Dayton
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Covered Entity Details
Entity Name
Kettering Health Dayton
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360133
Entity Address
405 W. Grand Avenue
Dayton, OH 45405
Medicare Provider Number
360133
Participating Start Date
7/1/2013
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #21370
5045 N MAIN ST
DAYTON, OH 45415
Pharmacy Comments
Contract Details
Approval Date
1/14/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Luis Chanaga, Vice President for Finance/Operations & CFO
(937) 723-3414
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2016
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