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Walgreens #21423
DSH230017 BRONSON METHODIST HOSPITAL
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Covered Entity Details
Entity Name
BRONSON METHODIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230017
Entity Address
601 JOHN STREET
KALAMAZOO, MI 49007
Medicare Provider Number
230017
Participating Start Date
7/1/2004
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
Walgreens #21423
Pharmacy Address
Walgreens Central Fill #21423
6275 Winchester Blvd
Canal WInchester, OH 43110-6537
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James B. Falahee Jr., Sr. Vice President, Legal & Legislative Affairs
(269) 341-8907
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/12/2023
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