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WALGREENS SPECIALTY PHARMACY, LLC
CAH521350-00 LANGLADE HOSPITAL - HOTEL DIEU OF ST. JOSEPH OF ANTIGO WISCONSIN; DBA ASPIRUS LANGLADE HOSPITAL
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Covered Entity Details
Entity Name
LANGLADE HOSPITAL - HOTEL DIEU OF ST. JOSEPH OF ANTIGO WISCONSIN; DBA ASPIRUS LANGLADE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521350-00
Entity Address
112 E. 5TH AVENUE
ANTIGO, WI 54409
Medicare Provider Number
521350
Participating Start Date
4/1/2011
Last Recertification Date
8/23/2024
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
1/15/2020
Contract Begin Date
4/1/2020
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
PAT TINCHER, Vice President-Finance, Regional Markets
(715) 847-2425
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2020
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