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WALGREEN CO.
RRC140135-00 Decatur Memorial Hospital
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Covered Entity Details
Entity Name
Decatur Memorial Hospital
Subdivision Name
Type
Rural Referral Center
340B ID
RRC140135-00
Entity Address
2300 N. Edward St.
Decatur, IL 62526
Medicare Provider Number
140135
Participating Start Date
7/1/2013
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05719
4995 E US ROUTE 36
DECATUR, IL 62521
Pharmacy Comments
Contract Details
Approval Date
1/14/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/14/2016
Pharmacy closed
Contacts
Covered Entity Signing Official
Deborah L. Bragg, Senior VP, Finance
(217) 876-2107
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2014
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