Contract Pharmacy Details

WALGREEN CO.
DSH240101 ST MARYS REGIONAL HEALTH CENTER

Covered Entity Details

Entity Name

ST MARYS REGIONAL HEALTH CENTER

Subdivision Name

Essentia Health St. Mary's

Type

Disproportionate Share Hospital

340B ID

DSH240101

Entity Address

1027 WASHINGTON AVE
DETROIT LAKES, MN 56501

Medicare Provider Number

240101

Participating Start Date

1/1/2015

Last Recertification Date

8/27/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

WALGREENS SPECIALTY PHARMACY #15309
2100 LYNDALE AVE S STE A
MINNEAPOLIS, MN 55405

Pharmacy Comments

Contract Details

Approval Date

1/15/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Ryan Hill, Administrator
(218) 784-5201

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/15/2020

340B Drug Pricing Program Database