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WALGREEN CO.
DSH520139 West Allis Memorial Hospital Inc. DBA Aurora West Allis Medical Center
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Covered Entity Details
Entity Name
West Allis Memorial Hospital Inc. DBA Aurora West Allis Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH520139
Entity Address
8901 West Lincoln Avenue
West Allis, WI 53227
Medicare Provider Number
520139
Participating Start Date
7/1/2014
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05459
9909 W LOOMIS ROAD
FRANKLIN, WI 53132
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GAIL HANSON, CFO
(414) 299-1623
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/17/2017
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