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WALGREEN CO.
STD489109 MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES
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Covered Entity Details
Entity Name
MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES
Subdivision Name
BUREAU OF HIV and STI PROGRAMS
Type
Sexually Transmitted Diseases
340B ID
STD489109
Entity Address
MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES, HIV/STI PROGRAMS, CLIENT AND PARTNER SERVICES DIVISION
111 W. Edgewood Blvd
Suite 11
LANSING, MI 48911-5680
Grant Number
NH25PS005170
Participating Start Date
4/1/2003
Last Recertification Date
5/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16475
555 MICHIGAN ST NE STE 100
GRAND RAPIDS, MI 49503
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
4/16/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tom Dunn, DHSP Operations Section Manager
(517) 335-7203
Contract Pharmacy Representative
Walgreens
Karl Meehan, VP Health System Programs
(847) 315-2663
Signed By Date
4/14/2021
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