Contract Pharmacy Details

WALGREEN CO.
DSH230053 HENRY FORD HOSPITAL

Covered Entity Details

Entity Name

HENRY FORD HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230053

Entity Address

2799 WEST GRAND BLVD
DETROIT, MI 48202

Medicare Provider Number

230053

Participating Start Date

10/1/2002

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA WALGREENS #16098
32910 MIDDLEBELT RD.
FARMINGTON HILLS, MI 48334

Pharmacy Comments

Contract Details

Approval Date

8/12/2014

Contract Begin Date

8/12/2014

Carve-In Effective Date

Contract Comments

08/12/2014 Immediate begin date authorized

Contacts

Covered Entity Signing Official

Joe Schmitt, Sr. VP & Acting CFO
(313) 876-8714

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

8/12/2014

340B Drug Pricing Program Database