Contract Pharmacy Details

WALGREEN CO.
DSH360134 THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO

Covered Entity Details

Entity Name

THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH360134

Entity Address

375 DIXMYTH AVE
CINCINNATI, OH 45220

Medicare Provider Number

360134

Participating Start Date

4/1/2006

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 07489
57 W MAIN STREET
AMELIA, OH 45102-1737

Pharmacy Comments

Contract Details

Approval Date

4/16/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/3/2018
Agreement registered in error

Contacts

Covered Entity Signing Official

Michael Crofton, Sr. Vice President & CFO
(513) 569-6577

Contract Pharmacy Representative

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

Signed By Date

4/16/2018

340B Drug Pricing Program Database