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WALGREENS SPECIALTY PHARMACY, LLC
PED173300-00 The Children's Mercy Hospital Kansas
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Covered Entity Details
Entity Name
The Children's Mercy Hospital Kansas
Subdivision Name
Type
Children's Hospital
340B ID
PED173300-00
Entity Address
5808 W. 110th Street
Overland Park, KS 66211
Medicare Provider Number
173300
Participating Start Date
4/1/2012
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
1/13/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian O'Neal, Senior VP of Allied Health
(816) 302-8059
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/13/2023
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