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WALGREEN CO.
CAH231339-00 Corewell Health Pennock Hospital
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Covered Entity Details
Entity Name
Corewell Health Pennock Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231339-00
Entity Address
1009 west Green Street
Hastings, MI 49058
Medicare Provider Number
231339
Participating Start Date
7/1/2019
Last Recertification Date
8/22/2024
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
7/9/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael King, Controller
(269) 948-3122
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/9/2021
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