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WALGREENS SPECIALTY PHARMACY, LLC
STD19405 Novus Adult Care Services
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Covered Entity Details
Entity Name
Novus Adult Care Services
Subdivision Name
Bridgeport
Type
Sexually Transmitted Diseases
340B ID
STD19405
Entity Address
512 DeKalb Street
Bridgeport, PA 19405
Grant Number
NH25PS005144
Participating Start Date
7/1/2021
Last Recertification Date
5/5/2025
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
4/29/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joe Mannino, CFO
(610) 419-0502
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2021
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