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WALGREEN CO.
CAH241361-00 MAYO CLINIC HEALTH SYS - NEW PRAGUE
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Covered Entity Details
Entity Name
MAYO CLINIC HEALTH SYS - NEW PRAGUE
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241361-00
Entity Address
301 SECOND STREET NE
NEW PRAGUE, MN 56071-1799
Medicare Provider Number
241361
Participating Start Date
7/1/2019
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12972
100 CHALUPSKY AVE. SE
NEW PRAGUE, MN 56071
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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