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WALGREEN CO.
DSH150146 COMMUNITY HOSPITAL OF NOBLE CTY INC
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Covered Entity Details
Entity Name
COMMUNITY HOSPITAL OF NOBLE CTY INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150146
Entity Address
401 SAWYER ROAD
KENDALLVILLE, IN 46755-0728
Medicare Provider Number
150146
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #15148
7950 W JEFFERSON BLVD STE 1B005
FORT WAYNE, IN 46804
Pharmacy Comments
Contract Details
Approval Date
7/19/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/9/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jeanne Wickens, CFO
(260) 373-8407
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/19/2017
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