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WALGREENS SPECIALTY PHARMACY, LLC
DSH240088 RICE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
RICE MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240088
Entity Address
301 BECKER AVE. SW
WILLMAR, MN 56201
Medicare Provider Number
240088
Participating Start Date
6/25/2018
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
6/25/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carnita Rae Allex, Administrator
(507) 637-4500 Ext: 47301
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/25/2018
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