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WALGREEN CO.
RWII49684 Munson Medical Center
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Covered Entity Details
Entity Name
Munson Medical Center
Subdivision Name
Thomas Judd Care Center
Type
Ryan White Part B
340B ID
RWII49684
Entity Address
5041 N. Royal Dr.
Suite 1
Traverse City, MI 49684
Grant Number
X07HA00044
Participating Start Date
4/1/2015
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 10186
1029 M 37 S
TRAVERSE CITY, MI 49685
Pharmacy Comments
Contract Details
Approval Date
10/10/2024
Contract Begin Date
1/1/2025
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
10/10/2024
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