Contract Pharmacy Details

WALGREEN CO
DSH130006 ST LUKES REGIONAL MEDICAL CENTER, LTD.

Covered Entity Details

Entity Name

ST LUKES REGIONAL MEDICAL CENTER, LTD.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH130006

Entity Address

190 EAST BANNOCK
BOISE, ID 83712

Medicare Provider Number

130006

Participating Start Date

7/1/2004

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA: WALGREENS #12123
3395 S. FEDERAL WAY
BOISE, ID 83705

Pharmacy Comments

Contract Details

Approval Date

1/15/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/26/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

Peter DiDio, Vice President, Controller
(208) 381-1251

Contract Pharmacy Representative

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

Signed By Date

1/15/2018

340B Drug Pricing Program Database