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WALGREEN CO.
CAH241338-00 MAYO CLNIC HEALTH SYSTEM - LAKE CITY
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Covered Entity Details
Entity Name
MAYO CLNIC HEALTH SYSTEM - LAKE CITY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241338-00
Entity Address
500 WEST GRANT ST
LAKE CITY, MN 55041
Medicare Provider Number
241338
Participating Start Date
10/1/2023
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12404
3142 S SERVICE DR
RED WING, MN 55066
Pharmacy Comments
Contract Details
Approval Date
10/11/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristin S. Johnson, Vice Chair Administration SE MN
(507) 434-9806
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2023
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