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WALGREENS SPECIALTY PHARMACY, LLC
DSH500058 Kadlec Regional Medical Center
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Covered Entity Details
Entity Name
Kadlec Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500058
Entity Address
888 SWIFT BOULEVARD
RICHLAND, WA 99352
Medicare Provider Number
500058
Participating Start Date
7/1/2007
Last Recertification Date
9/5/2024
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
Contacts
Covered Entity Signing Official
Spencer Dwayne Harris, CFO
(509) 942-2708
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2019
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