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WALGREEN CO
SCH230058-00 MUNSON HEALTHCARE GRAYLING HOSPITAL
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Covered Entity Details
Entity Name
MUNSON HEALTHCARE GRAYLING HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230058-00
Entity Address
1100 E Michigan Ave
GRAYLING, MI 49738
Medicare Provider Number
230058
Participating Start Date
4/1/2024
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10489
729 W HOUGHTON LAKE DR
PRUDENVILLE, MI 48651-8425
Pharmacy Comments
Contract Details
Approval Date
2/6/2024
Contract Begin Date
4/1/2024
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
1/16/2024
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