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WALGREENS SPECIALTY PHARMACY, LLC
PED453315-00 CHRISTUS Children's
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Covered Entity Details
Entity Name
CHRISTUS Children's
Subdivision Name
Type
Children's Hospital
340B ID
PED453315-00
Entity Address
333 North Santa Rosa Street
San Antonio, TX 78207
Medicare Provider Number
453315
Participating Start Date
4/1/2014
Last Recertification Date
8/15/2024
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
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stephanie Parker, VP Finance
(210) 704-3657
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2020
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