Contract Pharmacy Details

WALGREEN CO.
DSH150011 MARION GENERAL HOSPITAL, INC.

Covered Entity Details

Entity Name

MARION GENERAL HOSPITAL, INC.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH150011

Entity Address

441 NORTH WABASH AVENUE
MARION, IN 46952

Medicare Provider Number

150011

Participating Start Date

7/1/2010

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 09279
2620 S WESTERN AVE
MARION, IN 46953-3556

Pharmacy Comments

Contract Details

Approval Date

10/6/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/11/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

STEPHANIE HILTON-SIEBERT, CHIEF ADMINISTRATIVE OFFICER
(765) 660-7007

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/6/2017

340B Drug Pricing Program Database