Contract Pharmacy Details

WALGREEN CO.
RRC360070-00 CLEVELAND CLINIC MERCY HOSPITAL

Covered Entity Details

Entity Name

CLEVELAND CLINIC MERCY HOSPITAL

Subdivision Name

Type

Rural Referral Center

340B ID

RRC360070-00

Entity Address

1320 MERCY DRIVE N.W
CANTON, OH 44708

Medicare Provider Number

360070

Participating Start Date

7/1/2020

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 04101
5122 WEST TUSCARAWAS ST
CANTON, OH 44708

Pharmacy Comments

Contract Details

Approval Date

7/2/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

David K Stewart, SVP / COO / CFO
(330) 489-1007

Contract Pharmacy Representative

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

Signed By Date

7/2/2020

340B Drug Pricing Program Database