Contract Pharmacy Details

WALGREEN CO
CAH141301-00 Kirby Medical Center

Covered Entity Details

Entity Name

Kirby Medical Center

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH141301-00

Entity Address

1000 Medical Center Drive
Monticello, IL 61856

Medicare Provider Number

141301

Participating Start Date

4/1/2013

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA: WALGREENS #10800
424 W VAN BUREN ST
CLINTON, IL 61727-2130

Pharmacy Comments

Contract Details

Approval Date

4/5/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Steven D. Tenhouse, Chief Executive Officer
(217) 762-2115 Ext: 1501

Contract Pharmacy Representative

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

Signed By Date

4/5/2018

340B Drug Pricing Program Database