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WALGREEN CO.
DSH230132 HURLEY MEDICAL CENTER
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Covered Entity Details
Entity Name
HURLEY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230132
Entity Address
ONE HURLEY PLAZA
FLINT, MI 48503
Medicare Provider Number
230132
Participating Start Date
12/1/1992
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #21334
1419 N DORT HWY
FLINT, MI 48506
Pharmacy Comments
Contract Details
Approval Date
10/7/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Melany Gavulic, President & CEO
(810) 262-6887
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/7/2014
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