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WALGREEN CO.
CAH241333-00 MAYO CLINIC HEALTH SYS - ST. JAMES
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Covered Entity Details
Entity Name
MAYO CLINIC HEALTH SYS - ST. JAMES
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241333-00
Entity Address
1101 MOULTON & PARSONS DRIVE
ST. JAMES, MN 56081
Medicare Provider Number
241333
Participating Start Date
10/1/2023
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 10516
608 N BROADWAY ST
NEW ULM, MN 56073-1726
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
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
10/12/2023
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