Contract Pharmacy Details

WALGREEN CO.
DSH230236 METROPOLITAN HOSPITAL

Covered Entity Details

Entity Name

METROPOLITAN HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230236

Entity Address

5900 BYRON CENTER AVE SW
WYOMING, MI 49519

Medicare Provider Number

230236

Participating Start Date

7/1/2004

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #16475
555 MICHIGAN ST NE STE 100
GRAND RAPIDS, MI 49503

Pharmacy Comments

Contract Details

Approval Date

7/15/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Kris Kurtz, CFO
(616) 252-4844

Contract Pharmacy Representative

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

Signed By Date

7/15/2022

340B Drug Pricing Program Database