Contract Pharmacy Details

WALGREENS SPECIALTY PHARMACY, LLC
DSH300012 ELLIOT HOSPITAL

Covered Entity Details

Entity Name

ELLIOT HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH300012

Entity Address

1 ELLIOT WAY
MANCHESTER, NH 03103

Medicare Provider Number

300012

Participating Start Date

3/12/2021

Last Recertification Date

9/14/2022

Entity Termination Date

1/1/2023

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

7/16/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Michael Turilli, Vice President - Finance
(978) 430-1352

Contract Pharmacy Representative

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

Signed By Date

7/16/2018

340B Drug Pricing Program Database