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WALGREENS SPECIALTY PHARMACY, LLC
CAH241381-00 SANFORD THIEF RIVER FALLS
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Covered Entity Details
Entity Name
SANFORD THIEF RIVER FALLS
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241381-00
Entity Address
3001 SANFORD PARKWAY
THIEF RIVER FALLS, MN 56701-2819
Medicare Provider Number
241381
Participating Start Date
4/1/2011
Last Recertification Date
9/5/2024
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
1/15/2021
Contract Begin Date
1/29/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tiffany Lawrence, President and CEO, Fargo
(701) 417-2314
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2021
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