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WALGREEN CO.
CAH521337-05 ST. CROIX REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. CROIX REGIONAL MEDICAL CENTER
Subdivision Name
Unity Clinic
Type
Critical Access Hospital
340B ID
CAH521337-05
Entity Address
1504 190th Avenue
Balsam Lake, WI 54810
Medicare Provider Number
521337
Outpatient Facility Provider Number
528605
Participating Start Date
4/1/2013
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
COMMUNITY, A WALGREENS PHARMACY #16522
360 SHERMAN ST.
SUITE 100
SAINT PAUL, MN 55102
Pharmacy Comments
Contract Details
Approval Date
4/11/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Sally Bajak, CFO
(715) 483-0556
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/11/2019
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