Contract Pharmacy Details

WALGREEN CO.
RRC140135-00 Decatur Memorial Hospital

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

7/12/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

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

7/12/2016

340B Drug Pricing Program Database