Contract Pharmacy Details

WALGREEN CO.
DSH370091 Saint Francis Hospital

Covered Entity Details

Entity Name

Saint Francis Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH370091

Entity Address

6161 South Yale Avenue
Tulsa, OK 74136

Medicare Provider Number

370091

Participating Start Date

4/1/2012

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #12714
315 N. 193RD EAST AVE.
CATOOSA, OK 74015

Pharmacy Comments

Contract Details

Approval Date

7/14/2015

Contract Begin Date

10/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Eric Schick, Senior Vice President - Chief Financial Officer
(918) 494-8430

Contract Pharmacy Representative

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

Signed By Date

7/14/2015

340B Drug Pricing Program Database