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Walgreens #21423
CAH231322-00 MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
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Covered Entity Details
Entity Name
MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231322-00
Entity Address
14700 LAKE SHORE DRIVE
CHARLEVOIX, MI 49720-1931
Medicare Provider Number
231322
Participating Start Date
10/1/2012
Last Recertification Date
8/26/2024
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
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathleen M LaRaia, Vice President
(231) 392-8410
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2023
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