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WALGREENS SPECIALTY PHARMACY, LLC
CAH151319-00 Gibson General Hospital, Inc
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Covered Entity Details
Entity Name
Gibson General Hospital, Inc
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151319-00
Entity Address
1808 Sherman Drive
Princeton, IN 47670
Medicare Provider Number
151319
Participating Start Date
1/1/2012
Last Recertification Date
8/13/2024
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
10/1/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/29/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lois Morgan, VP/Chief Nursing Officer
(812) 385-9237
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/1/2018
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