Contract Pharmacy Details

WALGREEN CO
DSH230046 UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS

Covered Entity Details

Entity Name

UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230046

Entity Address

1500 EAST MEDICAL CENTER DRIVE
ANN ARBOR, MI 48109

Medicare Provider Number

230046

Participating Start Date

1/1/2004

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA: WALGREENS #10778
22318 PONTIAC TRAIL
SOUTH LYON, MI 48178

Pharmacy Comments

Contract Details

Approval Date

10/14/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jeffrey S. Desmond, Chief Medical Officer
(734) 936-5814

Contract Pharmacy Representative

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

Signed By Date

10/14/2016

340B Drug Pricing Program Database