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WALGREEN CO.
DSH140206 Humboldt Park Health
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Covered Entity Details
Entity Name
Humboldt Park Health
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140206
Entity Address
1044 N FRANCISCO AVENUE
CHICAGO, IL 60622
Medicare Provider Number
140206
Participating Start Date
7/1/2004
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 01375
1200 N DEARBORN ST
CHICAGO, IL 60610-8341
Pharmacy Comments
Contract Details
Approval Date
4/17/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gary Krugel, CFO
(773) 292-8208
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/17/2018
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