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WALGREENS SPECIALTY PHARMACY, LLC
PED103301-00 Nicklaus Children's Hospital
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Covered Entity Details
Entity Name
Nicklaus Children's Hospital
Subdivision Name
Type
Children's Hospital
340B ID
PED103301-00
Entity Address
3100 SW 62nd Avenue
Miami, FL 33155
Medicare Provider Number
103301
Participating Start Date
10/1/2011
Last Recertification Date
8/30/2024
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
4/5/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Perry Ann Reed, COO & President
(786) 624-2032
Contract Pharmacy Representative
Walgreens
Lisa Villarreal, Analyst, 340B Operations
(847) 964-6183
Signed By Date
4/5/2021
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