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WALGREEN CO.
CAH521305-00 MCHS-FRANCISCAN SPARTA
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Covered Entity Details
Entity Name
MCHS-FRANCISCAN SPARTA
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521305-00
Entity Address
310 W MAIN
SPARTA, WI 54656
Medicare Provider Number
521305
Participating Start Date
1/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07727
750 MANKATO AVE
WINONA, MN 55987-4829
Pharmacy Comments
Contract Details
Approval Date
4/3/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tanner Holst, Regional Chair-Administration SWWI
(608) 392-9705
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/3/2025
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