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WALGREEN CO.
DSH140208 ADVOCATE CHRIST MEDICAL CENTER
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Covered Entity Details
Entity Name
ADVOCATE CHRIST MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140208
Entity Address
4440 W 95TH ST
OAK LAWN, IL 60453
Medicare Provider Number
140208
Participating Start Date
7/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09357
833 W 115TH ST
CHICAGO, IL 60643-4619
Pharmacy Comments
Contract Details
Approval Date
10/11/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/9/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
ROBERT PEKOFSKE, VP FINANCE
(708) 684-5133
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2017
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