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WALGREENS SPECIALTY PHARMACY, LLC
RRC230216-00 MCLAREN PORT HURON
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Covered Entity Details
Entity Name
MCLAREN PORT HURON
Subdivision Name
Type
Rural Referral Center
340B ID
RRC230216-00
Entity Address
1221 PINE GROVE AVENUE
PORT HURON, MI 48060
Medicare Provider Number
230216
Participating Start Date
12/7/2021
Last Recertification Date
8/26/2024
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
12/21/2021
Contract Begin Date
12/21/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/12/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bridget Ann Sholtis, CFO
(810) 989-3749
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
12/21/2021
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