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WALGREENS SPECIALTY PHARMACY, LLC
DSH160028 ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM d/b/a CHI Health Mercy Council Bluffs
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Covered Entity Details
Entity Name
ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM d/b/a CHI Health Mercy Council Bluffs
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160028
Entity Address
800 MERCY DRIVE
COUNCIL BLUFFS, IA 51503
Medicare Provider Number
160028
Participating Start Date
4/1/2005
Last Recertification Date
8/19/2024
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
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/6/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MARIE KNEDLER, President
(712) 328-5067
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/17/2018
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