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WALGREENS SPECIALTY PHARMACY, LLC
CAH231319-00 ASPIRUS KEWEENAW HOSPITAL
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Covered Entity Details
Entity Name
ASPIRUS KEWEENAW HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231319-00
Entity Address
205 OSCEOLA STREET
LAURIUM, MI 49913
Medicare Provider Number
231319
Participating Start Date
1/1/2011
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
4/2/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/21/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jesse Tischer, Sr. Vice President, Enterprise Development & Operations
(715) 847-2553
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/2/2019
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