Contract Pharmacy Details

WALGREENS SPECIALTY PHARMACY, LLC
DSH250123 SINGING RIVER GULFPORT

Covered Entity Details

Entity Name

SINGING RIVER GULFPORT

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH250123

Entity Address

15200 COMMUNITY ROAD
GULFPORT, MS 39503-5307

Medicare Provider Number

250123

Participating Start Date

3/11/2022

Last Recertification Date

8/28/2024

Entity Termination Date

4/1/2025

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

4/8/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Heath Allen Thompson, Administrator Ancillary Services
(228) 818-1191

Contract Pharmacy Representative

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

Signed By Date

4/8/2022

340B Drug Pricing Program Database