Contract Pharmacy Details

WALGREEN CO.
DSH170122 Ascension Via Christi Hospitals Wichita, Inc

Covered Entity Details

Entity Name

Ascension Via Christi Hospitals Wichita, Inc

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH170122

Entity Address

929 N. St. Francis
Wichita, KS 67214

Medicare Provider Number

170122

Participating Start Date

1/1/2012

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05769
3333 E CENTRAL AVE
WICHITA, KS 67208-3121

Pharmacy Comments

Contract Details

Approval Date

10/26/2012

Contract Begin Date

10/26/2012

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Michael A. Wegner, Senior VP of Finance & CFO
(316) 268-8525

Contract Pharmacy Representative

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

Signed By Date

10/12/2012

340B Drug Pricing Program Database