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WALGREENS SPECIALTY PHARMACY, LLC
CH045207HA Cumberland Family Medical Center, Inc.
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Covered Entity Details
Entity Name
Cumberland Family Medical Center, Inc.
Subdivision Name
Otter Creek Academy Healthy Kids Clinic
Type
HRSA-Funded Health Center
340B ID
CH045207HA
Entity Address
1440 Old Bethel Church Rd
Alpha, KY 42633-6204
Grant Number
H80CS08218
Participating Start Date
4/1/2023
Last Recertification Date
2/20/2025
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
10/5/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ryan Smith, CFO
(270) 858-6655
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/5/2023
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