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WALGREENS SPECIALTY PHARMACY, LLC
DSH390256 MILTON S. HERSHEY MEDICAL CENTER
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Covered Entity Details
Entity Name
MILTON S. HERSHEY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390256
Entity Address
500 UNIVERSITY DRIVE
HERSHEY, PA 17033
Medicare Provider Number
390256
Participating Start Date
4/1/2004
Last Recertification Date
9/24/2024
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
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/8/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
Eric Strucko, Interim Chief Financial Officer
(717) 531-6122
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2019
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