Contract Pharmacy Details

WALGREEN CO.
SCH230222-00 MYMICHIGAN MEDICAL CENTER MIDLAND

Covered Entity Details

Entity Name

MYMICHIGAN MEDICAL CENTER MIDLAND

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH230222-00

Entity Address

4000 WELLNESS DRIVE
MIDLAND, MI 48670

Medicare Provider Number

230222

Participating Start Date

7/1/2020

Last Recertification Date

8/19/2024

Entity Termination Date

1/1/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 09079
1615 N SAGINAW RD
MIDLAND, MI 48640-7237

Pharmacy Comments

Contract Details

Approval Date

7/9/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Bryan Rex Cross, President
(989) 839-1322

Contract Pharmacy Representative

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

Signed By Date

7/9/2020

340B Drug Pricing Program Database