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WALGREENS SPECIALTY PHARMACY, LLC
DSH450132 MEDICAL CENTER HOSPITAL
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Covered Entity Details
Entity Name
MEDICAL CENTER HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450132
Entity Address
500 WEST 4TH ST.
ODESSA, TX 79761-5001
Medicare Provider Number
450132
Participating Start Date
4/1/1998
Last Recertification Date
8/28/2024
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
7/6/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matt D Collins, Vice President of Operations
(432) 640-2445
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/6/2020
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