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 #11395
56805 VAN DYKE AVE
SHELBY TOWNSHIP, MI 48316

Pharmacy Comments

Contract Details

Approval Date

10/20/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Edward Chadwick, EVP, Finance and Admin & CFO
(313) 876-8714

Contract Pharmacy Representative

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

Signed By Date

10/20/2015

340B Drug Pricing Program Database