Contract Pharmacy Details

WALGREEN CO.
SCH520019-00 ASPIRUS RHINELANDER HOSPITAL

Covered Entity Details

Entity Name

ASPIRUS RHINELANDER HOSPITAL

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH520019-00

Entity Address

2251 NORTH SHORE DRIVE
STE 100
RHINELANDER, WI 54501

Medicare Provider Number

520019

Participating Start Date

10/1/2024

Last Recertification Date

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #12545
108 W. WALL ST.
EAGLE RIVER, WI 54521

Pharmacy Comments

Contract Details

Approval Date

6/29/2012

Contract Begin Date

6/29/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Monica Hilt, Regional VP And Hospital President
(920) 831-8913

Contract Pharmacy Representative

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

Signed By Date

7/2/2012

340B Drug Pricing Program Database