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WALGREEN CO.
SCH240093-00 MAYO CLINIC HEALTH SYSTEM MANKATO
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Covered Entity Details
Entity Name
MAYO CLINIC HEALTH SYSTEM MANKATO
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH240093-00
Entity Address
1025 MARSH STREET
MANKATO, MN 56001
Medicare Provider Number
240093
Participating Start Date
7/1/2017
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07290
1270 MADISON AVENUE
MANKATO, MN 56001
Pharmacy Comments
Contract Details
Approval Date
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Travis C. Paul, Regional Chair of Administration SWMN
(608) 392-9716
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/11/2023
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