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WALGREEN CO.
STD489109 MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES
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Covered Entity Details
Entity Name
MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES
Subdivision Name
BUREAU OF HIV and STI PROGRAMS
Type
Sexually Transmitted Diseases
340B ID
STD489109
Entity Address
MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES, HIV/STI PROGRAMS, CLIENT AND PARTNER SERVICES DIVISION
111 W. Edgewood Blvd
Suite 11
LANSING, MI 48911-5680
Grant Number
NH25PS005170
Participating Start Date
4/1/2003
Last Recertification Date
5/12/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06911
12576 RILEY STREET
HOLLAND, MI 49424-8217
Pharmacy Comments
Contract Details
Approval Date
1/11/2022
Contract Begin Date
1/18/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tom Dunn, DHSP Operations Section Manager
(517) 335-7203
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/11/2022
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