Contract Pharmacy Details

WALGREEN CO.
CAH241333-00 MAYO CLINIC HEALTH SYS - ST. JAMES

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 # 09350
1123 E BLUE EARTH AVE
FAIRMONT, MN 56031

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

340B Drug Pricing Program Database