Contract Pharmacy Details

WALGREEN CO.
CAH231331-00 SPARROW IONIA HOSPITAL

Covered Entity Details

Entity Name

SPARROW IONIA HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH231331-00

Entity Address

3565 S. State Rd
IONIA, MI 48846

Medicare Provider Number

231331

Participating Start Date

10/1/2010

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS #12893
11980 FULTON ST E
LOWELL, MI 49331

Pharmacy Comments

Contract Details

Approval Date

10/12/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Bruce Shively, SHS-CFO Comm Hospitals and Comm Care
(517) 253-6140

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/12/2021

340B Drug Pricing Program Database