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WALGREENS SPECIALTY PHARMACY, LLC
CAH241329-00 LAKEWOOD HEALTH SYSTEM
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Covered Entity Details
Entity Name
LAKEWOOD HEALTH SYSTEM
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241329-00
Entity Address
49725 COUNTY 83
STAPLES, MN 56479
Medicare Provider Number
241329
Participating Start Date
9/24/2010
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
4/11/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa Bjerga, CHIEF FINANCIAL OFFICER
(218) 894-8352
Contract Pharmacy Representative
Lakewood Health System
BRIAN HINMAN, PHARMACY DIRECTOR
(218) 894-8458
Signed By Date
4/11/2019
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