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WALGREEN CO.
DSH140224 PRESENCE SAINT JOSEPH HOSP-CHICAGO
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Covered Entity Details
Entity Name
PRESENCE SAINT JOSEPH HOSP-CHICAGO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140224
Entity Address
2900 NORTH LAKE SHORE DRIVE
CHICAGO, IL 60657
Medicare Provider Number
140224
Participating Start Date
7/1/2021
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06727
4720 N MARINE DRIVE
CHICAGO, IL 60640-5120
Pharmacy Comments
Contract Details
Approval Date
1/15/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2016
Contacts
Covered Entity Signing Official
Elizabeth Early, Regional Chief Ambulatory and Ancillary Services Officer
(847) 316-3900
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2016
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