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WALGREEN CO
DSH240187 HUTCHINSON HEALTH
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Covered Entity Details
Entity Name
HUTCHINSON HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240187
Entity Address
1095 HIGHWAY 15 SOUTH
HUTCHINSON, MN 55350
Medicare Provider Number
240187
Participating Start Date
7/1/2017
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #11690
121 DEPOT DR
WACONIA, MN 55387
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/15/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Pamela J. Larson, CFO
(320) 484-4472
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/17/2017
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