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WALGREEN CO.
DSH140048 ADVOCATE SOUTHLAND HEALTH NETWORK
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Covered Entity Details
Entity Name
ADVOCATE SOUTHLAND HEALTH NETWORK
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140048
Entity Address
2320 E. 93RD ST.
CHICAGO, IL 60617
Medicare Provider Number
140048
Participating Start Date
10/1/2015
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 00147
3611 E 106TH ST
CHICAGO, IL 60617
Pharmacy Comments
Contract Details
Approval Date
12/5/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Kelly, VP Finance, Advocate Trinity Hospital
(708) 213-3004
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
12/5/2017
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