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WALGREEN CO.
CAH141341-01 PANA COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
PANA COMMUNITY HOSPITAL
Subdivision Name
Community Medical Clinic of Pana
Type
Critical Access Hospital
340B ID
CAH141341-01
Entity Address
101 EAST 9TH STREET SUITE 105
PANA, IL 62557-1716
Medicare Provider Number
141341
Outpatient Facility Provider Number
148508
Participating Start Date
7/1/2017
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09892
315 N WEBSTER ST
TAYLORVILLE, IL 62568
Pharmacy Comments
Contract Details
Approval Date
4/10/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Trina Casner, President & CEO
(217) 562-6313
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/10/2017
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