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WALGREEN CO.
DSH160033 GENESIS MEDICAL CENTER - DAVENPORT
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Covered Entity Details
Entity Name
GENESIS MEDICAL CENTER - DAVENPORT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160033
Entity Address
1227 EAST RUSHOLME
DAVENPORT, IA 52803
Medicare Provider Number
160033
Participating Start Date
1/1/2019
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06553
830 MIDDLE ROAD
BETTENDORF, IA 52722-4101
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mark Rogers, CFO
(563) 421-6513
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2017
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