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WALGREENS SPECIALTY PHARMACY, LLC
RRC160057-00 Southeast Iowa Regional Medical Center
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Covered Entity Details
Entity Name
Southeast Iowa Regional Medical Center
Subdivision Name
Type
Rural Referral Center
340B ID
RRC160057-00
Entity Address
1221 S. GEAR
WEST BURLINGTON, IA 52655
Medicare Provider Number
160057
Participating Start Date
1/1/2011
Last Recertification Date
9/10/2021
Entity Termination Date
4/1/2022
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
7/6/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jeremy Alexander, CFO
(319) 768-3280
Contract Pharmacy Representative
WALGREENS CO
KARL MEEHAN, VICE PRESIDENT,HEALTH SYSTEMS PROGRAMS
(847) 315-2663
Signed By Date
7/6/2021
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