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WALGREENS SPECIALTY PHARMACY, LLC
RRC520030-00 ASPIRUS WAUSAU HOSPITAL
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Covered Entity Details
Entity Name
ASPIRUS WAUSAU HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC520030-00
Entity Address
333 PINE RIDGE BOULEVARD
WAUSAU, WI 54401
Medicare Provider Number
520030
Participating Start Date
12/21/2022
Last Recertification Date
8/19/2024
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
1/3/2023
Contract Begin Date
1/11/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/26/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
PAT TINCHER, Vice President-Finance, Regional Markets
(715) 847-2425
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/3/2023
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