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WALGREENS SPECIALTY PHARMACY, LLC
CAH111305-00 Hospital Authority of Miller County DBA Miller County Hospital
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Covered Entity Details
Entity Name
Hospital Authority of Miller County DBA Miller County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH111305-00
Entity Address
209 N. Cuthbert St
Colquitt, GA 39837
Medicare Provider Number
111305
Participating Start Date
10/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
ALLIANCERX WALGREENS PRIME #12314
9775 SW GEMINI DR, STE 1
BEAVERTON, OR 97008
Pharmacy Comments
Contract Details
Approval Date
4/4/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Robin Rau, CEO
(229) 758-5954
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/4/2019
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