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WALGREEN CO
DSH140012 OSF Saint Katharine Medical Center
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Covered Entity Details
Entity Name
OSF Saint Katharine Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140012
Entity Address
403 EAST FIRST STREET
DIXON, IL 61021
Medicare Provider Number
140012
Participating Start Date
7/1/2024
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10938
1080 N. 7TH ST
ROCHELLE, IL 61068
Pharmacy Comments
Contract Details
Approval Date
7/13/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Anthony Evers, CFO
(815) 285-5521
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/13/2017
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