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WALGREEN CO
CAH231322-00 MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
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Covered Entity Details
Entity Name
MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231322-00
Entity Address
14700 LAKE SHORE DRIVE
CHARLEVOIX, MI 49720-1931
Medicare Provider Number
231322
Participating Start Date
10/1/2012
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #12534
1301 N US HWY 31
PETOSKEY, MI 49770
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Hepler, CFO
(231) 935-6702
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/17/2018
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