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Walgreens #21423
DSH230036 MyMichigan Medical Center Alpena
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Covered Entity Details
Entity Name
MyMichigan Medical Center Alpena
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230036
Entity Address
1501 W. CHISHOLM
ALPENA, MI 49707
Medicare Provider Number
230036
Participating Start Date
7/1/2019
Last Recertification Date
8/16/2024
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
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
michael joseph erickson, President
(989) 839-3378
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/13/2023
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