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WALGREENS SPECIALTY PHARMACY, LLC
SCH330008-00 WYOMING COUNTY COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
WYOMING COUNTY COMMUNITY HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH330008-00
Entity Address
400 NORTH MAIN STREET
WARSAW, NY 14569
Medicare Provider Number
330008
Participating Start Date
1/1/2024
Last Recertification Date
Entity Termination Date
10/1/2024
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
7/8/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Amy Jo Chase, Chief Financial Officer
(585) 786-8940 Ext: 4129
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/8/2021
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