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WALGREENS SPECIALTY PHARMACY, LLC
DSH390063 UPMC HAMOT
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Covered Entity Details
Entity Name
UPMC HAMOT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390063
Entity Address
201 STATE STREET
ERIE, PA 16550
Medicare Provider Number
390063
Participating Start Date
4/1/2015
Last Recertification Date
9/6/2024
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
7/12/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/19/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brad N Dinger, CFO
(814) 877-3739
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/12/2022
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